Damian Sendler It was decided to use four databases to gather information on palliative cancer care for children and adolescents from 1995 to 2015 in order to create a psychosocial standard for this field. Final synthesis included 73 papers from a total of 209 that were reviewed. The following topics need immediate attention: symptom assessment and intervention, direct patient report, effective communication, and joint decision-making. For children and teenagers with cancer and their loved ones, standardization of palliative care assessments and interventions has the potential to improve quality of care throughout the cancer trajectory.

Damian Jacob Sendler According to the World Health Organization, palliative care “improves the quality of life of patients and their families dealing with life-threatening illness, through the prevention and alleviation of suffering by means of early identification and impeccable assessment & treatment of physical, psychosocial & spiritual pain and other problems.”

Dr. Sendler Palliative care for children and adolescents with cancer should be integrated as early as possible, regardless of the patient’s prognosis. Palliative care should be incorporated into all health care settings as soon as possible, so that patients’ psychological, developmental, and spiritual well-being can be cared for in the context of their families and communities, as well as the physical aspects of cancer. An integrated, interdisciplinary approach to competent and compassionate care is advocated by the American Academy of Pediatrics: “in which the components of palliative care are offered at diagnosis and continued throughout the course of illness, whether the outcome ends in cure or death. ” Even in resource-limited health systems, the Worldwide Palliative Care Alliance (WPCA) recognizes the importance of palliative care as a human right for children,[4] requiring global collaboration for a resource-effective, evidence-based approach to best practice standards for early integration of palliative care for children and their families.

Damian Sendler

According to a review of the literature, palliative care for children with cancer and their families varies across settings and resources and has only recently included access to services similar to those offered to adults with cancer..

[5] Children and adolescents who are diagnosed with cancer experience significant symptom and psychosocial distress, according to empirical research. A standard of palliative care aims to improve specific aspects of comprehensive care, such as communication between the medical team and the patient and family, ongoing assessment of the needs of the patient and family, developmentally informed interventions, and tangible support during times of inpatient and home care transition. [6,7] The quality of life for pediatric cancer patients and their families can be improved through the prevention and alleviation of child and family suffering through the practice of compassionate and honest communication, symptom alleviation, and the psychosocial attentiveness incorporated by quality palliative care services. [5,8] Palliative care concepts were examined to see if they should be introduced early in the diagnosis process and throughout the course of treatment.

Damian Jacob Markiewicz Sendler Providing comprehensive palliative care includes assessing and intervening on behalf of patients’ physical and emotional symptoms. Several studies involving grieving parents and patient charts have found that children and adolescents with cancer suffer from a wide range of psychological side effects during and after cancer treatment, including anxiety,[11–13] depression,[11,13] distress, worry and sadness as well as a fear of dying alone. These symptoms can also include difficulty expressing one’s feelings and a sense of loss of perspective. [15] As the disease progresses, these psychological and social symptoms often worsen, and they go untreated. Chronic pain is a common symptom for families to witness at the end of a child’s life with cancer,[8,11,15,17]. [18] In a retrospective survey of 141 parents who had recently lost a child, more than a third admitted that if the child had been in excruciating pain, they would have considered hastening his or her death. As a result of the correlation between parental anxiety and quality of life and child anxiety and pain, palliative care as a standard of care may improve long-term family wellness outcomes.

Only four of the 26 end-of-life publications in pediatrics included patient-reported outcomes, six (23.1 percent) included parent-reported outcomes, and five (19.2 percent) included staff-reported outcomes, according to a systematic review.

[23] Research is needed to gather and document patient reports in order to ensure that primary stakeholders receive appropriate interventions and care. [24] Palliative care needs should be sought directly from children and adolescents in order to honor the patient’s voice while also incorporating the perspectives of their families. [25]

The meaning of being ill and the prognosis are important topics for children and their parents to discuss, and the involvement of the care team in these discussions may be important for each child[2].

[26] None of the 147 parents who discussed death with their child regretted having these crucial conversations, despite the fact that children are often aware of their impending death. [27] The presence of a child or adolescent during important conversations with a physician or family about a child or adolescent’s end of life or prognosis was rarely documented in chart reviews. [12,28] Furthermore, adolescent cancer patients and survivors describe the need for open and respectful communication in addition to providing psychosocial support. This is particularly important for adolescents with cancer. [29,30] Research with parents of children with cancer shows that accurate, clear, and understandable communication is beneficial to these parents’ views on communication. [17,31,32] Clear and compassionate communication with bereaved parents is linked to excellent care and improved psychosocial outcomes, according to cross-sectional surveys. [17,33–35] As the disease progresses, it becomes increasingly critical to maintain open lines of communication with those who are dealing with it.

Damian Jacob Sendler

Having the chance to speak with a doctor about their wishes for end-of-life care increases the likelihood that cancer patients will receive it in accordance with their preferences, according to a multi-institutional, long-term study of an adult cohort.

Damien Sendler When patients are actively involved in their own care, they are more willing to give up control of important medical decisions in favor of their loved ones, which increases the likelihood that unnecessary treatment will be avoided and that their children’s wishes will be honored. [37] Age-appropriate advance care planning was described as acceptable, useful, and helpful by adolescents with cancer. [38,39] The end-of-life preferences of a child or adolescent must be captured by all members of the comprehensive care team (social workers, psychologists, child life specialists, and clinicians), including the practicality of the location of death.

A similar study found that the families of children with cancer whose primary oncologist provided clear information about end-of-life treatment options were more likely to plan for their child’s final resting place.

[19] According to bereaved parents’ perspectives, there is a pressing need for more seamless and effective care transitions, particularly in the form of home care and respite support services that are well-versed in the psychosocial and symptom care requirements of children and adolescents [17,40–42] Having an end-of-life discussion with a multidisciplinary medical team before an emergency[13] increased the likelihood that parents would opt out of resuscitation efforts for their child with incurable cancer. As a result of high quality palliative care, it may be possible to plan the location of death rather than the location of death itself, which may be a more relevant outcome.

The most frequently cited barriers to introducing palliative care concepts are a lack of time [33,37,47,51–53] and a perception of cost [15,44–51]. As a result, reimbursement for palliative care conversations and services should be considered. As a result, there is a pressing need for improved palliative care education for general health care providers, as well as a lack of established support services and psychosocial professionals. [8,17,54–56] Palliative care guidelines could help alleviate some of these barriers, such as providers’ discomfort with palliative care conversations or misconceptions that palliative care is only beneficial when treatment is no longer effective.[2,19,23,38,57] [60]

Damian Sendler Patients and their families stand to benefit significantly from palliative care when it is offered as a standard of care to children and adolescents who have been diagnosed with cancer. In order to improve the psychosocial well-being of children battling cancer and their families, symptom burden assessment and intervention, as well as effective communication, must be prioritized. When resources are available, patients and their families should be supported in their transitions between care settings (whether in the hospital, ambulatory care, or at home). Patient preferences and long-term, multi-institutional studies should be integrated into future research, as well as considerations for staffing needs and psychosocial outcomes.

Family-centered palliative care concepts (symptom assessment and intervention; direct patient reporting; effective communication; and shared decision-making) should be available to children and adolescents with cancer as soon as possible in order to minimize symptom burden, ease suffering, effectively manage pain and provide preventative bereavement care. Not only patients, but also those in the child’s social and relational spheres, such as siblings, parents or guardians, grandparents or other extended relatives, are included in palliative care’s target population.

Dr. Sendler

Sendler Damian Jacob

Damian Jacob Markiewicz Sendler

Damian Sendler: Predicting clinical and operational outcomes in the workplace is critical to improving the quality of health care. There are only a handful of work environment variables that have this potent impact on health care worker well-being. From an operational standpoint, it’s helpful to think of HCW well-being as workers’ ability to “get the work done” and be ready for the next task or challenge, similar to leadership concerns about staffing levels. HCW emotional exhaustion is an essential metric that predicts clinical and operational outcomes, as well as patient and HCW outcomes. We will take a deep dive into this topic. Assessment and improvement of employee well-being are instructive for management and understanding of a workforce.
The impact and consequences of HCW burnout had already captured the attention of national and international health care leaders before the global pandemic of 2020 placed an even greater strain on busy and stressed HCWs. The World Health Organization, the National Academy of Medicine, the Combined Critical Care Societies, the Accreditation Council for Graduate Medical Education, and many others have all issued formal statements about the need to address burnout in the medical community.

Damian Jacob Sendler: Leaders are scrambling to make evidence-based decisions for several years now, and the existing peer-reviewed literature does not provide a clear road map. If you type “burnout” into PubMed, you’ll see an increase of more than 6-fold over the past two decades, with an even steeper increase in the last three years. There are fewer than 50 randomized controlled trials focusing on interventions to improve burnout among healthcare workers in the medical literature. Almost all of these studies have fewer than 100 participants and are classified as pilot studies because of the small sample size or short-term follow-up. The prevalence or epidemiology of burnout is discussed in many articles, but there is a lack of evidence to support theories and little guidance on possible solutions. Because of this lack of evidence, it’s not surprising that management struggles to manage employee well-being in a way that’s consistent and effective.

Dr. Sendler: Due to the lack of high-quality studies on HCW burnout, this review aims to identify environmental and psychologic factors that contribute to burnout, and synthesize evidence supporting effective interventions to reduce burnout and improve HCW well-being. It is our intention to present our findings from randomized controlled trials on brief tools to improve health care workers’ well-being, funded by the National Institutes of Health. One of the largest existing data sets for HCW well-being, these efforts have provided us with new insights and perspectives to add to the existing literature on tools to enhance well-being. HCWs, administrators, and researchers are encouraged to use this review as a framework for understanding the concept of HCW well-being and providing evidence-based interventions. In this review of HCW well-being, we will discuss the terminology, prevalence, causes, interventions, and the future of HCW work.

Dr. Christina Maslach’s classic definition of burnout is a psychologic syndrome characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment.

5 Psychological burnout has a similar effect on cognitive processing, altering the way people perceive and interact with the world around them. As a simpler and more general definition, we use in our research, burnout is characterized by a decreased capacity to benefit from the healing effects of positive emotions. 6,7 As a result, burnt-out people tend to focus on the bad things happening around them, rather than the good.

Burnout has been linked to lower levels of positive emotions9,10 just like depression and anxiety.

11 Positive emotions have been found to be a crucial link in the chain leading to a sense of greater meaning and purpose12, as well as a speedier recovery from emotional trauma. 13 Hope, for example, is a powerful tool for recharging our batteries. 14,15 Positive emotions have been shown to have a significant impact on a person’s cardiovascular health when compared to negative emotions and control groups. 16 In order to better understand how events or interventions affect burnout, we’ve conducted extensive research into the healing effects of positive emotions. This research helps us better understand how burnout can be increased or decreased in response to these effects.

In what ways has burnout changed over time? Using the job demands–resources model17 since 2001, it has been shown that increasing demands while decreasing resources creates stress on the workforce. 18 Burnout, low engagement, compassion fatigue, moral distress, and low-safety culture are all terms used to describe this phenomenon. Interestingly, the level of strain reported by the workforce is average rather than high when resources increase in line with demands, demonstrating how understanding the two fundamental principles of demands and resources is critical to understanding well-being in the workforce.

Gratitude, interest, and serenity are all examples of positive emotions that aid in the development of personal resources, such as social connections, intellectual abilities, and a desire to improve oneself.

19 Our well-being diminishes as we are unable to access positive emotions due to new or increasing demands at work. Not because the person is weak, but because our health care systems have failed to create environments that encourage employee well-being.
Consider the coronavirus disease 2019 (COVID-19) pandemic to illustrate the job demands–resources model. Stressors to the mental health of HCWs include social isolation, fear of infection, financial strain, unplanned homeschooling, and a lack of control over one’s own future. Additionally, the pandemic has provided HCWs with new resources, such as frequent and surprisingly meaningful opportunities for HCWs to see the inherent value of their work, to powerfully connect with patients, to be appreciated and seen as heroes, to exercise a sense of agency, and to experience deep camaraderie among their colleagues and connection to their organization.. At this time, it’s unclear if these and other resources found during the COVID-19 pandemic will be sufficient to prevent burnout in the event that demand exceeds supply.
As we talk about burnout and well-being, it’s important to define terms that are frequently misunderstood or misused. To be resilient, one must be in a state of psychological well-being that allows them to deal with and recover from a psychological setback. Resistant people are able to cope and have resources that support their health and well-being. 20 In other words, as we’ll see in the sections below under the heading “Addressing Burnout,” well-being is driven by factors and interventions at the individual and organizational (environmental) levels.

Is it possible to have both exhaustion as well as depressive symptoms at once? Despite the fact that depression and burnout share some characteristics, most researchers consider them to be two distinct concepts with their own set of criteria and features. Anhedonia, feelings of worthlessness, exhaustion, and changes in appetite or sleep are all symptoms of depression. It is a psychologic condition that can be either episodic or chronic. 21 The ICD-11 describes burnout as a syndrome caused by “chronic workplace stress that has not been successfully managed,” which is a phenomenon that occurs in the workplace. 21 According to the ICD-11, Dr. Maslach’s original definition of burnout includes feelings of exhaustion or depletion, increased mental distance from one’s job or feelings of negativism or cynicism about one’s job, and decreased professional efficacy as examples of the dimensions of burnout. A recent systematic review and meta-analysis found that burnout and depression are moderately (but not perfectly) correlated from 0.40 to 0.57 across large and diverse data sets, which is consistent with our own findings.6 23 Burnout and depression may appear to share some common characteristics (e.g., a lack of interest and impaired concentration), but the stigma associated with burnout is significantly lower than that of depression, so HCWs are much more willing to seek and use resources for burnout than for depression. Our empirical operationalization of burnout, which we define as “reduced access to positive emotions,” shows that the work environment has a significant effect on both individuals and groups. As a result of this acknowledgment, there is a shared responsibility between the individual and the organization, which suggests possible solutions to burnout.

Researchers often use a variety of psychometrically valid metrics for areas such as burnout, depression, work-life balance, and subjective well-being to assess well-being as a multidimensional construct. 24,25 The Maslach Burnout Inventory, first published in 1981, is currently the most widely used tool for assessing burnout. 26 Emotional exhaustion, depersonalization, and personal accomplishment, which is often equated to job satisfaction, are all assessed by this psychometrically valid and widely used survey27.
The Maslach Burnout Inventory’s emotional exhaustion domain is the most commonly used, despite its siblings, depersonalization and low personal accomplishment, both of which are also present. The first thing to note is that emotional exhaustion by itself has demonstrated sufficient reliability for use at the individual level. 28 According to ICD-10 revision criteria and the DSM-5, 5th edition, it can be used to distinguish between burnt-out outpatients and non-burnt-out outpatients who are suffering from work-related neurasthenia (DSM-V). 29,30 Third, emotional exhaustion consistently produces the highest and most consistent coefficient estimates, according to a psychometric meta-analysis (indicating that the items in the scale group together very well to assess the underlying construct). 31

A 5-item version of the original 9-item emotional exhaustion scale is frequently used to reduce the burden on participants when multiple well-being domains are being assessed. Using this 5-item version, HCWs can predict the prevalence of disruptive behaviors and symptoms of depression,22 as well as HCW work-life balance, Improvement readiness (HCPs’ ability to initiate and sustain quality improvement initiatives)34 and the use of Patient Safety Leadership WalkRounds are also associated with the HCW emotional exhaustion assessments with this 5-item version. 33 Using this scale, we found that assessments of health care workers were consistently responsive to treatment. 33 Supplemental digital content at https://meridian.allenpress.com/aplm in the September 2021 table of contents provides an overview of how to assess burnout, interpret results, and compare yourself to others.

Damian Jacob Markiewicz Sendler: The opposite of emotional exhaustion would be measures of well-being, which have historically been used less frequently on HCWs than on the general population. An important distinction is that the absence of something bad does not necessarily mean the presence of something good. In recent years, there has been a growing interest in assessing the positive aspects of well-being among healthcare workers (HCWs). Scales for measuring positive well-being in health care environments were found to be lacking, so we developed and tested new ones. 6 Resilience was found to be divided into two categories: One is Emotional Thriving, which asks about a person’s ability to thrive (eg, “I get to use my strengths every day at work”), and the other, Emotional Exhaustion, which asks about a person’s level of exhaustion. After adversity or emotional upheaval comes Emotional Recovery, which measures one’s ability to bounce back (eg, “My mood reliably recovers after frustrations and setbacks”)

It has been estimated that 40 to 50 percent of physicians in the United States are burned out, according to recent data.

37 It’s no surprise that there’s a wide range of differences based on regional specialties and geographic locations. 38–40 Burnout definitions and thresholds used in different studies are also a major source of variation. There is a higher rate of burnout among US doctors than among workers in other professions. 37,41 In contrast to other highly educated workers, physicians experience higher levels of burnout despite having more years of education under their belts than those in other professions. 41 Nurses, like physicians, report varying levels of burnout depending on their specialty, workplace, and country of residence. Nursing burnout is estimated to be in the 35–45 percent range, but this may vary significantly depending on the subspecialty or work environment in which the nurse works. However, evidence suggests that burnout isn’t significantly different for other roles such as therapists or technologists, even though there are fewer data on the prevalence of burnout in those fields. 6,22,48 Burnout can be measured in large populations, but it is more important for leaders to understand the local rate of burnout in any given work environment because of the wide variation in burnout.

Burnout has a wide range of negative effects on individuals, including job dissatisfaction and the desire to leave the profession,49 poor sleep, lower-quality interpersonal relationships, a weakened immune system, depression and suicide, and even a shorter lifespan.

50–54 Burnout has far-reaching consequences that go beyond the health care providers who suffer from it. It costs $4.6 billion per year in the United States alone because of the increased turnover and decreased productivity caused by burnout in the health care industry. A HCW’s ability to provide patient care is harmed in almost every way by burnout. 55 Medical errors, infections, hospital admissions, mortality, and patients’ dissatisfaction have all been linked to overworked doctors, who are more likely to suffer from burnout. 56–64 Nurse burnout was the only thing that remained after adjusting for severity of illness, nurse-to-patient ratio, and other potentially confounding variables in one study. 57 An extensive study of 831 work settings from 31 Michigan hospitals found that higher levels of emotional exhaustion were consistently linked to lower teamwork and safety norms, lower ratings of local leaders, poorer work-life balance, and higher levels of burnout in their peers, when work settings were compared by emotional exhaustion quartiles.

Burnout can be compared to a microbiologic disease process by many clinicians. The disease is burnout, the pathogen is the environment, and the immune system is the resiliency of the individual. Thus, an individual who works in a toxic environment (ie, an aggressive pathogen) is at risk of becoming ill, regardless of their personal resilience, whereas an individual who is immunosuppressed may be at risk of burnout even in supportive environments. This theory may shed light on why different people, even when confronted with the same problems, may or may not show signs of burnout.

Think of our surroundings like the pathogen that wears us down and leads to burnout when considering this analogy. However, just as a live attenuated vaccine helps the immune system get ready for future attacks, certain aspects of our work and home environments also help us become more resilient. Meaningful work with leadership recognition, opportunities for personal growth, considerate and supportive colleagues, and leaders who promote autonomy, psychological safety, and adaptability can all be found in these work environments. Personal health, family dynamics, and meaningful social interactions all contribute to a person’s ability to cope with stressful situations at work.

Changes to health care systems are strongly advocated in recent perspectives, taskforces, and national collaborations on HCW well-being. 267 These authors advocate a populist approach to burnout in their articles, urging someone else to take care of everything from the medical record to staffing to workflow. Systemic problems are a significant factor in burnout, and both of these viewpoints have merit. But we believe this approach is lacking in scope when it comes to the actions that must be taken. We must fix both the system and the people who were harmed by it in order to promote well-being. There is strong evidence that one-third to one-half of our health care workers are currently experiencing burnout. Burnout is a contentious issue, so don’t be surprised if an HCW shouts, “Don’t talk about burnou\t, you just fix the system!” at a burnout meeting. Be prepared for these encounters, listen with compassion, and figure out where they are coming from if you’re in charge of well-being initiatives in your company. Leaders can examine the root causes of HCW burnout in order to find ways to improve their employees’ well-being. As a result of the many different causes of burnout, it is important to realize that no single intervention will work for all workers. Consequently, it is critical to understand the context in which an organization operates before deciding on a particular organizational intervention. Leaders risk wasting time and money on an intervention only to discover later that it was only a short-term fix or made no difference in the level of employee burnout. However, patient safety leader walkarounds (described in the following section), for example, may have little or no effect in an environment with an already strong safety culture.

It is also important to note that burnout frequently results from cumulative stressors, so single interventions may be less effective than combined interventions, or opportunities for HCWs to choose between interventions. It is critical for health care leaders to take a comprehensive approach to both organizational and individual factors that influence well-being in order to reduce burnout. Burnout can be exacerbated if organizations fail to address the causes and potential remedies for it. By failing to do so, we risk inadvertently sending the message that a person is only burned out because they are weak or resilient. Messages like these only serve to exacerbate the underlying problem by making employees feel powerless and unsupported by their leaders. Organizational resilience efforts will benefit from an increased focus on personal interventions because many employees will not be able to address their own burnout through workplace interventions alone. It’s a huge undertaking to gather and comprehend the well-being offerings and resources available at the workplace, departmental, institutional, and health system levels. Duke University (Durham, NC) spent over two years cataloging and assembling all of its well-being resources, and it is constantly in need of updates. The ability of leaders to promote and support more comprehensive well-being efforts that give HCWs options is made easier by classifying resources as either organizational or individual in nature.
Burnout in healthcare workers (HCWs) can be reduced through both organizational and individual-level interventions, according to two meta-analyses of these interventions’ effectiveness.

68,69 As a result of these studies, it appears that organizational interventions can have a greater cumulative impact than individual interventions. Unfortunately, organizational interventions require more resources and may be more difficult to maintain than personal interventions.

Systematic alterations to work conditions, such as workloads, resources, and interactions with supervisors and coworkers, are the primary focus of organizational efforts to promote well-being. Aside from being in a position of authority, individuals have little power to influence aspects of the workplace that are the focus of an organization’s interventions.

HCW burnout has risen sharply in recent years, in part because of an increase in the demands placed on HCWs.

Damien Sendler: Healthcare workers face a slew of challenges, including the 24-hour nature of their work, increasing medical and social complexity of patients, increased documentation demands through electronic medical record systems, financial constraints, and a lack of administrative support for clerical tasks. However, physicians who are already feeling the effects of exhaustion are more likely to reduce their clinical effort in the next 48 months. 72
One of the most common methods for reducing physician burnout is to streamline workflow or add clinical support. A number of studies have found a reduction in burnout as a result of efforts to reduce workload. 72,73 Patient-to-nurse ratios can be reduced by adding more advanced practice providers or medical assistants or by offloading clerical duties. These are all examples of interventions. 73–75

The job demands–resources model shows that burnout is not solely a result of increased workload, but rather a result of a combination of factors. When increased demands are not met with increased resources and support from the organization, burnout occurs. Using this information, leaders can ensure that new demands on HCW time are balanced with an increase in resources allocated in order to improve workflow or workload.

HCW well-being is also influenced by work-life balance, which has been scientifically proven to be true.
32,36 Hours worked, number of nights in the hospital, long-duration shifts and consecutive days at work have been linked to burnout. 76–79 Data on work-life balance and burnout are inconclusive, so it’s difficult to draw conclusions. Burnout among medical students and residents hasn’t decreased significantly since the implementation of work-hour restrictions.

Many studies have shown a 20% to 60% higher risk of burnout in women compared to men, which is a significant difference.
82,83 A combination of rising household and child care costs and a growing sense of dissatisfaction with the state of work-life harmony may be to blame for these consequences. 84 Gender differences in burnout have decreased as more women have entered the health care field in recent years. 85 Those under the age of 55 are twice as likely to experience burnout as those over the age of 55. Another risk factor for burnout in the health care workforce is having a spouse or partner who is not a health care worker. 87 Health care leaders, medical schools, and the health care system may benefit from policies and programs designed to specifically counteract some of the culturally ingrained barriers to well-being (eg, robust antidiscrimination and bullying; equitable pay).

Personal well-being and burnout: a broader perspective
89 has prompted a slew of healthcare organizations to implement employee wellness initiatives. More than 4000 employees across 20 hospitals in the United States participated in a large randomized controlled trial of a wellness program that improved self-reported exercise and weight control, but there was no difference in clinical or employment outcomes. 59 Many organizational interventions for personal well-being face this challenge, which is exacerbated by conflicting data on the effects of work hours and the short-term nature of many workflow interventions. Their success is dependent on a significant investment of organizational resources, and they may fail to produce the desired results if they are not properly targeted, promoted, and maintained.

Employees who feel like they have a say in their work environment, as well as some degree of autonomy, are more likely to be engaged. When these highly-trained professionals feel like cogs in a wheel rather than partners, engagement drops and burnout rises. 38,90–92 The lack of engagement that results from employees believing they have no voice at work can be combated by leaders focusing on interventions to engage and empower frontline employees. Leader walkarounds, originally developed by Frankel et al93 and later modified by Pronovost et al94, are a method for executives to support and promote quality improvement efforts.. Leader walkarounds have been linked to improved safety culture93,95 and reduced burnout,96 especially when feedback is provided following the walkaround. 33
Another strategy to empower HCWs by leveraging resources for HCWs is to intentionally involve staff in decision-making and problem-solving. There are strong correlations between safety culture and well-being domains, such as improvement readiness, leadership, teamwork, emotional exhaustion, burnout climate and growth opportunities and career advancement when employees participate in decision-making. 33 If you’re involved in quality improvement projects, you’re less likely to get burned out even though it may increase your work load.73 Burnout appears to be countered by a sense of agency that comes from working to solve some of the day-to-day problems that cause it. You should, however, provide well-being resources, role model the use of them, and make options available to HCWs in work environments that are experiencing burnout before requesting them to show up early and stay late for new quality improvement–related projects.

Workers’ daily experiences and perceptions of work can be profoundly influenced by a sense that local leadership and the organization “has your back.”

92 Staff well-being is influenced by perceptions of local leadership, and a 3.3% reduction in burnout is associated with each point increase in the composite leadership rating. 90 We have also found that HCW assessments of effective leadership are associated with lower rates of emotional exhaustion (J.B.S. unpublished data, July 2020). “Second victims,” those who have been affected by an error, a bad outcome, or a crisis that is unrelated to patient care, need leadership support the most. 97 HCWs involved in medical errors are commonly referred to as second victims in the context of medical errors, with the primary victim being the patient who was harmed. Second victims often report feelings of guilt, shame, moral distress, professional inadequacy, and burnout,98 and in some cases, symptoms of Posttraumatic Stress Disorder (PTSD). 99 Second victims may also be afraid of retaliation or leave the field entirely. 100 A study of more than 1000 nurses found that higher levels of support from management, nurse peers, and physician colleagues buffered against the association between involvement in preventable adverse events and higher burnout. 101 Emotional exhaustion and a better safety culture are reported by HCWs who report that their organization supports second-victims.

The rudeness or incivility of coworkers or patients can have a profound effect on the mood of a team or work environment. 106 Many health care workers report higher levels of emotional exhaustion and depression when they are regularly exposed to rudeness and civility at work, according to a large study involving almost 8000 participants. 22 Staff turnover, deteriorating teamwork, and growing mistrust of management are all exacerbated in an environment marred by disruptive behaviors. Formal professionalism programs, policies that are clear, predictable, and enforced, and engaged leaders who are willing to have difficult conversations are all part of the organization’s efforts to combat disruptive behaviors. The first step is to create a culture where it is safe to discuss and provide feedback on these behaviors. 107 After this point, nonpunitive methods like peer messenger programs have been successfully implemented to reduce the frequency of routine disruptive behaviors, saving punishment for the most severe cases.

Damian Sendler

As a result of the Schwartz Center for Compassionate Healthcare’s efforts, the Schwartz Rounds were created to give healthcare providers an opportunity to openly and honestly discuss the social and emotional issues they encounter while caring for patients and their loved ones.

111 In these multidisciplinary case conferences, patients and health care professionals discuss the psychosocial aspects of challenging cases. With repeated attendance, healthcare workers who have participated in Schwartz rounds report a reduced sense of stress, improved interpersonal relationships, an enhanced ability to deal with psychosocial issues in care and an increased sense of shared purpose. 112–115 Expecting similar results from activities that focus on the psychosocial aspects of care and link HCWs’ daily work to patients’ and families’ benefit is reasonable.
Physicians’ meaning in their work and job satisfaction have been boosted by the Mayo Clinic’s COMPASS program (Colleagues Meeting to Promote and Sustain Satisfaction).
69 A meal is provided, and small groups of six to ten doctors meet during a designated period of time during the workday. Using question prompts, a group leader can elicit discussion on topics that are representative of the stresses that physicians face on a daily basis. Socialization and relationship-building activities were also included in the schedule. When compared to a control group, the COMPASS program showed improvements in empowerment and engagement, as well as a decrease in depersonalization, over the course of the study. Participants in the COMPASS study also reported higher levels of job meaning, but there were no differences between the COMPASS group and the control group in terms of stress, depression symptoms, or job satisfaction. Importantly, these organized efforts to increase the significance of groups of HCWs show promising first steps into a world of deliberate efforts to improve the well-being of organizations, which many leaders are afraid to enter or are completely unaware of.

The availability of various options for HCWs to select individual interventions that suit their particular situation and needs goes hand in hand with organizational efforts to improve well-being. There are a few common threads that run through the various interventions that people can use to improve their resilience and combat burnout. Preventing burnout by increasing positive emotions is the first and most important step you can take. The second set of strategies focuses on self-care activities such as meditation and other forms of introspection. An individual’s job satisfaction can also be improved by implementing techniques that help them find meaning in what they do. Taking part in activities that one enjoys, values, is not difficult, and does not cause one to feel guilty is the best way to improve one’s life, according to research. 116
Burnout sufferers are concerned about their tendency to focus on negative information and potential threats in the environment, rather than noticing positive aspects of the environment. People with higher levels of burnout spent less time looking at uplifting images and more time looking at images that made them feel bad, according to a study using eye tracking technology. 8 Because burnout prevents people from noticing positive events and interactions, their lives become an endless stream of negative experiences, which only serves to exacerbate their state of exhaustion.
Burnout is linked to a focus on negative events, but it is also a predictor of death. A strong link between heart disease mortality and the number of negative tweets (reflections on things going wrong) was found in a large study of Twitter feeds in the northeastern United States. 117 However, there was a link between fewer deaths and positive tweets. In a different study, researchers discovered that young nuns who showed a lot of happiness lived on average ten years longer than their less happy counterparts. 118 Reflecting on the positive is linked to global well-being, according to this article.

When it comes to a “negativity bias,” humans have a hard-wired preference for negative stimuli. “The negative screams at you, but the positive only whispers,” says Barbara Fredrickson, a pioneer in this field. 119 It is a survival mechanism for mammals to be able to recognize, remember, and respond quickly to things that could harm us. 120 The “flight or fight” response is activated at these times, and we see a host of physiological responses, including increased heart rate, blood pressure, and respiratory rate, as well as increased levels of stress hormones, such as adrenaline and cortisol. 121 When we think about the bad things that have happened in our lives, we tend to dwell on them for long periods of time, which can lead to chronic conditions, such as high blood pressure and heart disease. 122
Burnout can be countered by retraining the brain to focus on the good things in life instead of the bad.

24,123 Love, joy, amusement, hope, awe, serenity, inspiration, interest, pride, and gratitude are all positive emotions that can be cultivated. In this context, the goal of positive psychology is not to ignore negative experiences, but to restore a balance between positive and negative experiences in order to promote well-being and happiness. 124 As a result of September 11, 2001, research found that people of all well-being levels were affected by feelings of anxiety, distress, and anger, but those with higher levels of well-being were more likely to see the event as temporary rather than permanent.

Damian Jacob Sendler

“undoing effects of positive emotion” have been demonstrated by Barbara Fredrickson and her colleagues13, which refers to the ability of positive psychology to aid in physiologic recovery following stressful events. In her studies, she’s found that activities that increase feelings of well-being help the body’s vital signs return more quickly to normal after a stressful event. 13

“Three Good Things” has been the most extensively researched method for promoting positive emotions. According to Seligman and colleagues,24 this exercise asks participants to write down three things they are grateful for each night. At the conclusion of the study and six months later, a randomized controlled trial found increases in happiness and decreases in depressive symptoms as a result of using this tool. 24 After just 15 days, a study of healthcare workers found that practicing the “Three Good Things” method led to a decrease in emotional exhaustion and depression, as well as an increase in overall happiness and a more balanced work-life balance over the course of one month, six months, and 12 months of follow-up (Figure 4). 6 After 15 days, participants reported less emotional exhaustion and more emotional thriving and recovery, as well as fewer signs of depression and greater contentment in their work and personal lives, according to a second study. 7 At 6- and 12-month follow-ups, improvements in emotional exhaustion, emotional recovery, depressive symptoms, and work-life balance remained (Figure 5). 95.8 percent of Three Good Things participants said they would recommend the exercise to a friend; 85.3 percent said they had encouraged others to participate in the exercise; and 92.7 percent said they would participate in the exercise again in the future.

Another important predictor of happiness is the quality of one’s social relationships, which has been linked to better cardiovascular and immune system functioning as well as lower levels of stress and depression. 129–133 Social isolation has been found to be just as harmful to your health as smoking more than 15 cigarettes a day, and even more harmful than regular physical activity or a person’s BMI. 129 Similarly, a poor immune response to immunization has been linked to college students’ levels of loneliness. 134 Negative interactions with coworkers, as previously discussed in organizational interventions, appear to be a significant factor in HCW burnout. 22 Study of 20 intensive care units found that informal social interactions with coworkers outside of work and one-on-one conversations amongst colleagues were the most common interventions associated with improved staff well-being 112 This idea of “other people mattering”135 is embodied in our bite-sized well-being tool, 1 Good Chat, which aims to promote meaningful interactions with other people.

Mindfulness meditation, as well as its more recent iterations of self-compassion, have a lot going for them in terms of quality research.

143 Burnout can be alleviated with regular mindfulness meditation training, which has gotten a lot of attention recently. As it turns out, mindfulness training for healthcare workers has been found to have significant moderate effects on anxiety, depression, and psychologic distress as well as a small to moderate effect on burnout and wellbeing in recent meta-analyses of 38 randomized control trials. 144 It’s also been proven that integrating mindfulness into clinical practice is beneficial. At Krasner and colleagues145 we have an 8-week program for primary care physicians on mindfulness, communication and self-awareness. These results were consistent at a 15-month follow-up. They found that mindfulness training had a positive impact on burnout (emotional exhaustion, depersonalization, and personal accomplishment), empathy, and mood disturbances. Qualitative analysis revealed that doctors were satisfied with the training because it allowed them the chance (1) to connect with colleagues to lessen professional isolation, (2) to improve mindfulness skills to better attend patients’ needs and respond more effectively, and (3) develop greater self-awareness in their practice. 146 Some healthcare workers (HCWs) are interested in mindfulness programs for burnout, but others aren’t. A further drawback for many HCWs is the time it takes to complete the required training (typically 8 to 10 weeks or 75 total hours). 146,147 Many of these insights, such as the development of mindfulness, self-compassion, and serenity, have been condensed into our bite-sized well-being tools.
Data show that cultivating positive emotions, self-care and mindfulness can have a positive impact on one’s well-being even though evidence is still in its infancy in this area. Figure 4 shows a rough approximation that can be compared across a few of the interventions. When it comes to emotional exhaustion, the Three Good Things intervention is comparable to mindfulness meditation and coaching. Each intervention has a similar effect on the population as a whole, but the benefits to specific individuals will differ. To put it another way, cultivating positive emotions has long-term benefits, but the most impactful and long-lasting positive emotions will differ for different people. Our recommendation is to try one of these interventions, as well as to consider additional ones, for leaders and health care workers (HCWs).

There are many factors that contribute to the well-being of health care workers, but their impact on patient and organizational outcomes cannot be denied. As a result of their inability to cope with stressful and emotionally draining situations, health care workers suffer from a pathology known as health care worker burnout.
As health care leaders, it is critical that we demonstrate that the well-being of our employees is a top priority for our organization. There is no one-size-fits-all approach to improving the health of a healthcare organization. Using a variety of interventions in tandem is expected to have a greater impact on well-being, especially when addressing the various organizational and individual factors. In order to achieve long-term well-being, it is necessary to address existing HCW burnout while also implementing well-being strategies into the company’s culture.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: An important part of reducing cancer mortality at the population level is early detection through organized screening. It is critical that those who have been invited to participate in screening programs do so. As a result, uptake rates are below average across screening programs, indicating that patient factors must be clarified in order to develop strategies that are based on evidence. Behavioral interventions have been shown to be effective in increasing cancer screening uptake, according to this review of individual-level (sociodemographic and psychosocial) factors. The authors discuss current trends and future directions in behavioral cancer screening research in order to overcome challenges and address unmet needs in cancer mortality reduction.

Damian Jacob Sendler: As the world’s population ages, so does the cancer burden it carries. Estimates suggest that, by 2040, there will be 28.4 million new cases of cancer worldwide, up from an estimated 19.3 million in 2020 and a staggering 10 million deaths from the disease [1]. Early detection of cancer is critical to lowering the death toll from the disease. Many countries have set goals to improve cancer detection and treatment. When it comes to cancer diagnosis, the National Health Service in England has set a goal of increasing the percentage of people diagnosed at an early stage from about 50–75 percent by 2028.

Dr. Sendler: A key component of any national cancer strategy is the early detection of cancer and precancer through screening of asymptomatic people. High-quality randomized trials show that organized screenings are effective in reducing cancer mortality [3–6]. Therefore, many countries have established national screening programs for breast, cervical, and colorectal cancer. Lung cancer screening is currently being expanded internationally, and prostate cancer screening is available but not recommended as an organized program. There are many countries where cancer screening has been implemented in high- and middle-income countries such as Europe and North America, but it is less common in low and middle-income countries.

Using evidence known to the authors as well as evidence gathered through ad hoc’scoping’ searches, this review examines the role of patient factors in cancer screening uptake. The authors use the original research authors’ interpretations to highlight the most significant developments. According to the authors, evidence of prostate cancer screening uptake is relevant for other cancer screening programs, such as colorectal and lung cancer screenings.

Evidence from the United Kingdom and the United States is the primary focus of the authors, supplemented by evidence from other countries that have implemented cancer screening programs in the past. Patient factors in cancer screening have been largely studied in the UK and US, indicating that current knowledge may not be universally applicable to screening uptake globally and the need for additional research in various cultures and health systems. However, while country-specific nuances of screening programs and their organization can make it difficult to transfer lessons learned in one country to another, evidence from both countries provides insight into patient factors in cancer screening in two contrasting healthcare systems. This study Cancer screening in the United Kingdom is free at the point of delivery, supported by the UK National Screening Committee, and includes a systematic call and recall of eligible patients based on their registration with a primary care physician. Patients in the United States, on the other hand, can self-refer and discuss screening with their doctor through health insurance or government-run health programs, as there is no centrally organized cancer screening program in the country. Cancer screening recommendations from the US Preventive Services Task Force and the UK National Screening Committee are currently in place.

An adequate screen (a definitive test result) can be defined as the percentage of those invited who receive it within a specified time after their test. Uptake has been cited as the most critical determinant of the success of a screening program for cancer [17]. There are a slew of good reasons for everyone to get screened for cancer. There must be a sufficient number of cancers detected early enough to make the program cost-effective, and high uptake ensures this. A lack of screening could lead to a widening disparity in cancer survival because of disparities in uptake among different sociodemographic groups. For example, those who are most likely to develop cancer may not be screened because of the ‘inverse care law,’ a potential problem for screening.

A cancer screening program’s benefits should outweigh its drawbacks. A reduction in cancer-specific mortality, lower health care costs, increased awareness of the disease and its symptoms, and emotional reassurance are among the possible benefits of telemedicine. Potential harms include overdiagnosis, false-positive results, and unnecessary treatment leading to greater costs, the associated risks and complications of diagnostic procedures, and emotional distress to the patient.. Screening participation is not just about increasing the number of people who participate; it’s about making informed decisions that take into account the potential costs and benefits of participating [19]. In order to make an informed and autonomous decision that is consistent with one’s own values and beliefs, one must have access to information about the possible consequences [20]. Cancer screening participation should therefore be up to the individual and not dictated by an authoritative figure.

According to data from the National Health Interview Survey in the United States, uptake of cancer screening varies by cancer type: 81.3 percent for cervical screening, 71.7 percent for breast screening, and 63.4 percent for colorectal screening [21]. In England, 72.2 percent of National Health Service cancer screening programs are used for cervical screening, 69.1 percent for breast screening, and 579 percent for colorectal screening. Different cancer screening methods and ‘at-risk’ populations are shown to have different uptake rates, highlighting the difficulty of identifying barriers to screening that may differ between screening programs (Table 1).

Colorectal screening methods can change from country to country; for example, a simple fecal immunochemical test (FIT) has replaced the guaiac fecal occult blood test (FOBT) for colorectal cancer screening in many countries, while more invasive flexible sigmoidoscopy and colonoscopy methods are still used in some countries. In addition, the screening guidelines for the National Health Service are reviewed on a regular basis [25], for example, a proposed age extension to the service’s breast cancer screening program. Although new developments have been made, much of the prior research on patient factors and the various influences on screening behavior is still relevant to current screening methods and techniques.

To reduce cancer mortality, it is necessary to understand patient factors associated with cancer screening uptake (including sociodemographic characteristics such as age and psychosocial factors such as perceived risk of cancer) and to use behavioral science to inform interventions to promote greater participation in screening programs. Patient factors are recognized as only one part of the multilevel influences on screening behavior [26], but they are crucial for increasing cancer screening uptake.

It is the goal of this review to provide a narrative summary of the evidence relating patient factors to cancer screening participation, to describe advances in behavioral strategies to promote uptake and to examine current and future challenges in the field of cancer screening behavior. Various sociodemographic and psychosocial factors, such as an individual’s ability, motivation, and opportunity to participate in cancer screening, are examined by the authors. A variety of behavioral mechanisms are also considered by the authors as interventions that operate at the individual level. In the future, cancer screening developments could have a significant impact on patient involvement. Cancer screening uptake has been linked to a variety of patient factors, and these factors have been evaluated for their ability to increase screening uptake. These associations and effects are discussed in the overview, but no quantitative data are presented in a systematic manner, which makes it difficult to identify knowledge gaps and future research directions that need to be addressed through the collection of additional data.

Compared to men, women are consistently more likely to participate in colorectal cancer screening in the UK [24,28,29] and in the United States [21]. [30] Colorectal cancer screenings are less common among men than women in Australia. A number of factors, including the screening method and setting, can influence the association between gender and the uptake of colorectal cancer screening. It was found that men were more likely to use the FIT test than women in a pilot study in England, which reduced the absolute difference from 5.7% to 3.6% [32].

It’s possible that women are less likely than men to have their lungs screened for cancer, but this evidence comes from clinical trials, not the general population who is screen-eligible [33]. When it comes to lung cancer screening in the United States, where uptake has been extremely low (less than 18 percent since it was recommended), there are no gender differences in uptake or return for a second annual screening. It is unlikely that sexism has any significant impact on cancer screening uptake, as differences between genders are small.

Age is a significant factor in both the UK and the US when it comes to breast cancer screening. There was a 68.2 percent uptake of breast cancer screening in women ages 50–52 and 73.2 percent in those ages 65–70 in England in the 2018–2019 period [23]. [23] Data from the age extension trial, which only included women aged 45–49 years, backs up this trend. Only 66.5 percent of those women participated. Compared to the United Kingdom, the age gap in breast cancer screening participation is smaller in the United States. [37] Women 65–74 years old have a slightly higher participation rate than those 50–64 years old (72.2 vs 71.3 percent). It has also been found that older men are more likely to undergo colorectal cancer screening than younger men [38].

Because of the broader age range targeted, there is a more complicated relationship between age and cervical screening. Increases in England’s coverage (the percentage of eligible population who have been tested and are in good health) are seen in younger age groups, but then declines in older age groups [22]. Uptake in the US reaches its pinnacle among people aged 30 to 39 years old [39]. The 60–74-year-old age group is more likely to adhere to lung cancer screening than younger and older age groups, according to research [36]. Two studies found no age-related differences in screening uptake, while one found a higher percentage of 65–80-year-olds screened than those 55–64-year-olds screened (16.5 vs. 12.4 percent) [34,40]. Age does not appear to have an effect on the uptake of lung cancer screening in pilot programs in the UK [41].

Screening for cancer has a well-established socioeconomic gradient. When it comes to breast, cervical, and colorectal cancer screenings, women who live in lower socioeconomic areas are less likely to go [43,44] and are also less likely to have been screened for any of these three diseases at all [45]. In a study of women in Scotland, greater deprivation was associated with lower uptake of breast and colorectal screening than cervical screening [44]. Even though the gradient is less apparent for income and cervical screening in the United States [21], higher education and income are associated with greater likelihood of recent breast and colorectal cancer screening in the United States. In other countries, such as Italy and South Korea, lower colorectal screening uptake has been observed in more disadvantaged groups [48]. Participation in lung cancer screening in the United States is higher among those who have a high school education compared to those who do not [47]. In contrast to other types of cancer screening, those who have completed at least a high school education are also less likely to have been screened, and only time will tell if this association persists as lung screening becomes more widely used.

Nonwhite ethnic groups have a consistently lower rate of cancer screening uptake. All three major cancer screening programs in the United Kingdom are less popular in ethnically diverse areas, particularly among South Asians [50–53]. More than 70% of non-Hispanic African American women have undergone a mammogram in the United States, while only 69% of Hispanic women have had the procedure, according to a study published in the Journal of the American Medical Association. [37] Data from countries other than the United Kingdom were insufficient to draw conclusions about ethnic group participation in FOBT colorectal cancer screening programs [48]. According to US statistics, African American/Black women are more likely (74.6 percent) than white or Hispanic/Latina women (68.4 percent) to get a cervical screening (68.6 percent ) [54]. In Australia, Aboriginal and Torres Strait Islander people are less likely than non-Indigenous people to undergo cancer screening (e.g., 34% vs. 56%) [55,56]. White participants in a meta-analysis were found to be more likely to participate in lung cancer screening than nonwhite participants. [36] Factors associated with minority status, such as language and cultural barriers, may play a role in ethnic disparities. Immigrants in Norway had a 53.1 percent screening rate for breast cancer compared to 76.1 percent for nonimmigrants. The data from Norway showed that the gap narrowed as the length of time spent in the country increased, suggesting that barriers to assimilation are linked to acculturation.

Damian Jacob Markiewicz Sendler: To participate in cancer screening, people need to know more about the disease and how it’s detected. A high level of public knowledge about cancer screening programs has been found, particularly in the case of more established programs [59–61]. As a result of these misconceptions, cancer screening may not be necessary if there are no cancer symptoms present [63,64]. Nonetheless In a nationally representative US sample, those who avoided learning about cancer risk had lower rates of colorectal cancer screening [65]. Minority ethnic groups in England had lower levels of knowledge than whites, and this may be due to language barriers [66, 67]. Breast and FOBT screenings, but not cervical or flexible sigmoidoscopy screening, were found to be less well understood by ethnic minorities and lower socioeconomic status groups in England, a population-based survey found [63]. It is critical for screening participants to be educated about the advantages and disadvantages of screening, but screening invitations may lack the information necessary to promote this knowledge and informed choice [68,69].

Those who have a learning disability are less likely to participate in cancer screenings than the general population. [44] A study of women with learning disabilities found that they participated less in all three cancer screening programs in Scotland. Colorectal and breast cancer screening participation was lower among women with depression or greater multimorbidity in the same study. The uptake of cancer screening is particularly low in people with psychosis or more severe mental health problems [71–73]. Colorectal cancer screening participation in England was linked to better self-rated health and mediated the relationship between socioeconomic status and uptake significantly [74]. If a patient is already receiving cancer treatment or has a medical condition that prevents them from participating in a screening, they may not be able to participate.

There is a link between low health literacy and lower cancer screening rates [76,77]. Low health literacy and numeracy may also be significant barriers to informed cancer screening, according to studies that show better health literacy is associated with greater screening knowledge, lower cancer fatalism (the belief that death from cancer is inevitable), and a more positive attitude toward screening [78].

Negative emotions like anxiety and fear play a larger role in theories explaining health-protective behavior than do positive emotions like joy and happiness. Anxiety about breast, cervical, and colorectal cancer is a motivator for screening, but moderate anxiety appears to be more motivating than low or high anxiety [79–81]. Fear has been shown to have a complex relationship with uptake, acting as both a barrier and a facilitator in cancer screening in general [82]. Groups that are least likely to participate in cancer screening [83,84] are more likely to experience feelings of fear, worry, and disgust, whereas in the absence of screening, people’s fear of cancer can motivate them to attend [85]. In addition to screening invitations, screening methods, and the possibility of abnormal test results, other sources of fear can act as a barrier. Screening for breast, cervical, and colorectal cancers is hindered by a fear of embarrassment, discomfort, or pain [81,87–90]. Disgust at handling stool samples is a predictor of avoiding routine colorectal cancer screenings [91]. Different aspects of emotion can influence decision-making and action-taking processes, according to the evidence..

A wide range of studies have consistently found that the best predictor of future behavior is the person’s past behavior. As a result, past screening participation is the most important predictor of future screening participation [92], and people who have participated in one cancer screening program are much more likely to participate in additional screening programs [44]. Because of the different levels of uptake observed, this suggests that screening programs face common and unique barriers to participation [93]. Increasing the number of first-time participants may be a key factor in increasing the number of people who attend.

As a result of the possible risks, most people are enthusiastic about cancer screening. It’s not clear how much information about screening’s benefits and drawbacks affects attitudes. For example, even when people are informed about the dangers of cancer screening, they still have a favorable attitude toward it [69]. True-positive mammogram results were more acceptable to women who had previously received a false-positive result [96]. People who have been misdiagnosed and overtreated as a result of screening are more likely to believe that they owe their health to screening, which is called the ‘Popularity paradox’ [97]. There is evidence to suggest that people’s attitudes are resistant to information about screening’s risks, and that people don’t necessarily make deliberative decisions about screening attendance by weighing the risks and benefits.

A lack of interest in routine screenings for breast, cervical, and colorectal cancers is linked to cancer fatalism in both the United Kingdom and the United States [74,98]. Concerns about practicality and cleanliness of the screening method appear to be a greater barrier to colorectal cancer screening than for breast or cervical screening [45]. According to some reports, people go to cancer screenings for altruistic reasons, such as the belief that screenings are an efficient use of health-care resources [64,99] and a form of medical research that can advance science [100].

Damien Sendler: There was a correlation between higher efficacy beliefs about cancer screening and greater uptake of colorectal cancer screening in a sample of English adults aged 60–69 [74]. Overestimation of mammography’s effectiveness was found in women in the United States, United Kingdom, Italy, and Switzerland, with a higher number of accurate estimates negatively associated with having undergone screening in the preceding two years [101]. A UK study [102] found a link between lower health literacy and a person’s self-efficacy in regards to colorectal cancer screening. South Asian ethnicity and lower uptake in England and Scotland were linked through self-efficacy [103].

Risk perceptions are known to play an important role in health behavior, but they are difficult to measure, limiting our understanding of the link between screening uptake and risk perceptions. Cancer screening participation is associated with increased cancer risk perception, but individuals may be overly optimistic about their own chances of developing the disease [105]. Screening decision-making is influenced by benchmarks or ‘candidates,’ which have been discovered through qualitative research [106-107]. Affective risk perception (also known as ‘affective risk perception’) can be triggered by a person’s beliefs about the severity of a disease, such as cancer, and by known risk factors like a family history of cancer or tobacco use [108]. Objective cancer risk factors may only be weakly associated with people’s risk perceptions. Through further research, it is necessary to gain a better understanding of the nature and impact of risk perceptions

In the United States, screening intentions for breast, colorectal, and prostate cancer are predicted by perceived norms [111]. Among men and those from ethnic minorities, a study in England found that cancer stigma was more prevalent among those who participated irregularly or not at all in any of the three national screening programs [112]. Cultural taboos such as the prohibition on exposing one’s body to strangers or the association between cervical cancer and promiscuity [86] may make cervical screening an even more taboo subject for some ethnic groups. Lung cancer screening has been hampered by the stigma of cancer as a self-inflicted disease [113]. As a result, smokers in the United States are less likely to participate in lung cancer screening compared to nonsmokers [114], while smokers in the United Kingdom are less likely to participate in colorectal screening [80].

Cancer screening uptake can be influenced by an individual’s environment and resources. When compared to the United States, people who live in urban areas may be less likely to attend church services in the UK [47,115]. Rural areas in the United States may have a greater distance barrier than urban areas, which may account for this disparity. Making an appointment and relying on others to carry out daily activities are two other possible practical barriers to cancer screening [81,92]. Nonattendance is linked to a lack of social support, as well as being unmarried [31,88]. It is common for colorectal cancer screening to be offered as a home test kit, which can be perceived as a barrier to participation [93,99]. The invitation may not have reached some screening nonattendees [117], perhaps because they have relocated.

There is some evidence that psychosocial factors can explain the influence of well-established sociodemographic factors on cancer screening uptake. Screening uptake is influenced by socioeconomic factors such as lower health literacy and knowledge, greater cancer cynicism, higher perceived cancer stigma in more deprived groups [74,84]. Sociodemographic factors may also play a role in the intention–behavior gap by predicting screening intention more accurately than behavior. As a result of this information, behavioral interventions to encourage cancer screening uptake have been developed and targeted.

Screening invitation reminders are a good way to increase the number of people who accept the invitation. Post, phone, or text message are all effective methods of distributing them. First-time invitees were more likely to show up for their screening appointment if they received a text message reminder 48 hours before their scheduled appointment, compared to the control group. For women who did not respond to the first invitation, a postal reminder increased cervical screening uptake by 9% in absolute terms compared to no reminder. In those who had not yet responded, a follow-up phone call boosted uptake by 31% more than it would have been without it [122]. In England, text message reminders didn’t have an overall impact on colorectal screening uptake, but they had a significant impact on first-time invitees (40.5 vs. 34.9 percent). A small effect on colorectal cancer screening was found in a systematic review, which found that text messaging interventions had a modest effect on breast and cervical cancer screening uptake [124]. Colorectal cancer screening kit return rates can be improved with advance notification letters [125], but the UK has found that they are ineffective at encouraging the return of cervical screening self-sampling kits [126]. A systematic review of international studies found that reminders increased adherence to lung cancer screening. The effectiveness of personalized reminders has also been studied. It was found that sending a follow-up letter that reiterated the original invitation to undergo colorectal cancer screening increased uptake overall and was more effective in the most deprived areas [127]. Electronic physician and primary care provider prompts to recommend screening for nonattenders in ambulatory settings increased breast and colorectal cancer screening, but not cervical screening, in a meta-analysis [128]. Patients who receive reminders are more likely to show up because they are less likely to forget. They are also more likely to plan ahead of time. Cancer screening inequalities may be reduced through the use of reminders, which appear to be particularly effective in first-time invitees and areas of greater deprivation [129].

To make things as simple for themselves as possible, people often choose to act in a way that is different from what they would normally do. With the help of default options, screening programs have found that providing a fixed appointment time on invitations has boosted the number of women who participate in breast and cervical screening [92,130]. Using a second timed appointment to send reminders to people who missed their first breast cancer screening appointment has also been found to be effective [131]. To avoid inefficiency and waste due to missed appointments, this strategy lessens the burden on the invitee in terms of preparation. FIT and HPV self-sampling kits need to incorporate goal-setting and planning techniques in order to avoid the ‘easier’ option of delaying and not responding to a test.. By allowing patients to change their office hours for a breast cancer screening, a 2.8% increase in uptake was observed, with 7% opting for an evening or weekend appointment instead of an office appointment [132].

There is a link between mass media campaigns and increased cancer screening uptake in areas where organized screening is readily available [136]. Campaigns of this type can aim to disseminate information about screening, challenge preconceived notions, alleviate anxieties, and set an example for others to follow. In Australia, for example, a television ad campaign resulted in an 18 percent increase in cervical screening and an 11 percent increase in colorectal cancer screening kit return, with a greater impact on those who had never participated before. Increases in cancer screening may also be linked to media coverage of high-profile deaths from the disease [139].

Screening for colorectal cancer was found to have a 3.6 percent higher attendance rate when materials addressed known barriers were used compared to standard materials [141]. Participation in colorectal cancer screening increased by 6% as a result of an improved procedural leaflet [142]. There were no significant differences in uptake between low-literacy or low-numeracy groups when supplemented with simplified summaries of key information and a narrative leaflet containing personal screening stories designed to improve comprehension by people with low literacy or numeracy [127]. Redesigning written information, especially in low-literacy areas, may have little effect on uptake. In a study conducted in the United States, a clinic-based research assistant evaluated a sample of low-literate people and found that 11.4 percent returned all three subsequent annual FOBT kits, compared to 4.7 percent who did not receive the education [143]. The education included a demonstration of how to complete the kit. More intensive support from a clinic nurse, such as phone contact and problem solving, resulted in a greater uptake in another group of participants (13.6 percent ). Even though uptake is still low and such support requires significantly more resources, this shows the potential for personal support to promote uptake without relying on written materials The use of illustrations and social media techniques should be explored as evidence-based health communication methods [144,145].

Damian Sendler

Framing screening messages by comparing them to descriptive social norms (highlighting what is commonly done) rather than injunctive norms (highlighting what other people approve of) may have a greater impact. Descriptive norms run the risk of “reactance” and unintended consequences. Injunctive norms, on the other hand, can prevent these. African Americans are more likely to get screened for prostate cancer if they have a stronger sense of racial identity than those who don’t, according to the effects of subjective norms on prostate cancer screening participation [152]. When people are encouraged to think about the negative consequences of not getting screened for breast cancer, loss-framed messages appear to be slightly more effective than gain-framed messages at increasing the likelihood of getting screened. Studies on colorectal cancer screening found similar results [154]. An accompanying ‘affective booster’ (for example, the opportunity to anticipate and feel relief at receiving a negative test) increased the message’s persuasiveness in the gain-framed condition, according to the authors of this study. Colorectal cancer screening participation was not affected by a theory-based intervention that was delivered with prenotification letters that included a questionnaire about anticipated regret. However, those with low intention to participate were more likely to participate. Cervical screening was found to be more popular among those who received the regret messages in a similar intervention [156]. There are some questions about whether these approaches are able to facilitate autonomous and informed decisions because they are focused on automatic and affective decision-making rather than rational and reflective cognitive decision-making. The impact of information design strategies on information comprehension and values-aligned decisions, as well as their effect on uptake, must be evaluated.

Helping people make specific plans about screening participation is one way to close the gap between their intentions and their actions. This is what they’re aiming for, and they’re doing it by making goals and taking action (e.g., making if-then plans, or implementation intentions). According to one study, a colorectal cancer screening information leaflet with three pre-formulated implementation intentions was not effective at increasing uptake of screenings. There were no statistically significant differences in the number of women attending breast cancer screenings between those who completed three implementation intentions and those who did not [158]. User participation in the design and development of planning interventions is critical to their success [159]. Existing motivation to participate in screening and engagement with the support tool are among the factors that may determine their effectiveness. In contrast to mailing in a test kit, attending a screening appointment requires a different type of action. The former requires time, travel, and a social context, whereas the latter allows for greater personal control over where and when screening occurs. Other health behaviors [160] have demonstrated the effectiveness of planning support tools, indicating a need to investigate their applicability in cancer screening programs as well.

Evidence of individual-level behavioral interventions that aim to restructure the individual’s environment, modify information design, and support planning has been summarized by the authors in this review. Reminders, simplified information, and easy-to-understand tests are all likely to improve the effectiveness of interventions [161]. [161] Improved understanding of how and why interventions work can help improve cancer screening uptake, and interventions at multiple levels (such as provider and patient level) may be more effective [162].

Sociodemographic and psychosocial variables have been shown to influence cancer screening uptake. Other variables appear to be associated with the overall uptake of cancer screenings, whereas others are specific to individual screening programs. Such information enables the development and evaluation of intervention strategies based on solid evidence. Cancer mortality can be reduced through increased screening uptake with behavioral support, but it is critical that intervention development builds on existing research and theory. Screening should be simplified, the amount of time it takes to participate reduced, and people should be supported in planning participation and responding to barriers. screening providers should implement interventions that have been proven to be effective, many of which can be implemented at a low cost.

Individual differences in cancer risk and the potential benefits of cancer screening are gaining attention as a way to improve cancer screening programs’ efficiency and reduce the harms they cause. There has been an increase in the use of a risk-stratified screening approach, which focuses on those at higher risk of cancer and those at low risk of cancer. Breast cancer screening programs across the country are already incorporating risk stratification. [163] According to the findings of a 2019 independent review of screening in England, a single advisory body should oversee both targeted screening and population screening. It is also being studied to improve the criteria for selecting patients for lung cancer screening using multivariate models rather than just age and smoking history, as is the current recommendation in the United States. Risk communication can benefit from the insights of behavioral science. Screening information tailored to the individual’s beliefs and concerns, as well as a tailored risk approach, may be more effective in promoting participation. In order to avoid exacerbating already-existing inequalities in screening uptake, risk-stratified screening should take into account public attitudes, beliefs, risk perceptions, and emotions.

Damian Jacob Sendler

Generic tests or simple biomarker tests have been used to stratify cancer risk in recent years due to advances in genomics and cell biology. [165] Stool, urine, blood, and exhaled breath are all examples of biomarker tests that can be used to screen for multiple types of cancer in a single sample. It is possible that these tests could be more effective and less harmful at detecting early cancer than existing tests because they are faster and more cost-effective to perform. New screening methods may be able to detect cancers that can be treated at an early stage, such as ovarian, liver, and pancreatic cancers, more effectively than current screening methods. As a result of these developments, questions arise about the role of patients in cancer screening. For example, how will a blood test to detect lung cancer be received and perceived? There are an increasing number of screening tests available, each with their own unique characteristics and potential benefits and drawbacks. Behavioral science may be able to help answer these questions and develop interventions based on scientific evidence to help spread awareness and encourage participation in a cancer screening program using a new test.

More people may be at risk of overdiagnosis due to the development of new tests and an increase in cancer screening in many countries. Overdiagnosis must be better understood by the public, and the “popularity paradox” must be avoided. Informed decision-making about cancer screening participation requires this, but it may be difficult to achieve and requires evidence-based health communication methods. Screening uptake does not have to drop if people are made more aware of the risks of screening and the fact that the program is effective in reducing cancer burden when everyone participates. Behavioral interventions that prioritize patient autonomy are needed in the pursuit of greater uptake and informed uptake. As a result, there may be a shift to behavioral techniques that educate rather than manipulate and support people in acting in accordance with their values and intentions. Screening decisions that reflect a patient’s values, priorities, and attitudes toward risk can be supported by the use of decision aids. While screening for breast and colorectal cancer, the use of decision aids was found to reduce participation [166,167]. Because of the uncertainty about the balance of benefits and risks for an individual, a risk-based approach may necessitate accepting that better information may lead to lower overall uptake.

The ‘at-risk’ population, primarily those with a long history of smoking, will necessitate special consideration when the lung cancer screening program is implemented. There is a high level of public awareness of the cancer risk associated with smoking, which may lead to an increase in cancer screening participation among those who are eligible. High levels of cancer fear, according to behavioral theory, may lead to screening avoidance rather than attendance in the absence of high levels of self-efficacy for screening [168]. The American Thoracic Society recommends the use of patient navigators as outreach workers to help the most vulnerable overcome barriers, shared decision-making tools that are suitable for low literacy and numeracy levels and for different cultural backgrounds, and the use of telehealth and mobile screening units to overcome geographic barriers [169]. For those who are more likely to live in areas of high deprivation, the use of media such as letters and leaflets has been shown to increase uptake by 53%. False assurance from negative screening results can also have an unintended effect on smokers’ motivation to quit smoking, a potential unintended harm of lung cancer screening. Patients’ factors should be carefully monitored and appropriate behavioral interventions, such as smoking cessation support tailored to individual screening experiences, developed as lung cancer screening becomes more common.

As a result of efforts to reduce inequalities, there has been a significant reduction in breast cancer screening uptake disparities between the most and least deprived groups in England [172]. Improved service design is still needed to break down cultural and linguistic barriers and improve uptake among underserved populations. It’s important to address the unique barriers faced by groups such as those with a learning disability or mental illness because there is currently a lack of evidence about appropriate behavioral support [173]. In order to ensure informed decision-making, screening information should clearly explain the possible benefits and harms, but this assumes that people make rational decisions, when the evidence in this review suggests that automatic motivation (like emotions or habits) is an important determinant of screening participation. Research on nonresponders to screening invitations is often limited to sociodemographic factors rather than psychosocial ones. To better understand the link between screening participation and various patient characteristics in underserved populations, more resources will be needed to conduct research methods that can effectively engage nonresponders.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: COVID-19 has a profound effect on mental health. There have been a number of concerns about the pandemic’s effect on gambling since the beginning of the epidemic. In light of the restrictions imposed by public health authorities, such as physical distancing and lockdowns, many actors are concerned about a shift to online gambling. Because online gambling is regarded as a high-risk activity, this change is concerning. Therefore, we need to learn more about how the pandemic is affecting the gambling industry. Scoping reviews aim to summarize the literature on the effects of the COVID-19 pandemic on gambling. This review is a scoping review of that literature. According to our research, this is the first review to focus on this topic.

Damian Jacob Sendler: Research on COVID-19 and gambling is limited and the pandemic’s impact on gambling behavior and gambling-related issues remains unconfirmed. To better understand the impact of the pandemic on gambling, more research is needed, both qualitative and mixed methods studies. We need to be careful, especially with problem gamblers and other groups of people who appear to be more susceptible to gambling during this pandemic period.

Dr. Sendler: Significant consequences have been caused by the pandemic of COVID-19. Individuals, businesses, healthcare systems, and the economy are all feeling the effects of the COVID-19 crisis. The extent of the pandemic’s collateral damage has only recently been realized.

There is a crisis in mental health because of COVID-19. Since the beginning of the pandemic, anxiety and depression have become more common (Rajkumar, 2020). There is a strong correlation between stress and substance abuse among people who live alone, as has been documented in the past: (Volkow, 2020). The same thing has been observed with regard to gambling during a crisis (Economou et al., 2019; Jiménez-Murcia et al., 2013; Olason et al., 2015)..

There has been a recent increase in the recognition of gambling disorder as a major public health issue (Abbott, 2020; Delfabbro and King, 2020; Korn and Shaffer, 1999; Korn et al., 2003; Messerlian et al., 2005; Shaffer and Korn, 2002; van Schalkwyk et al., 2019; Wardle et al., 2019). Gambling addiction affects anywhere from 0.12% to 5.8% of the population (Potenza et al., 2019). Gambling disorder is defined in the DSM-5 as a long-term and recurrent problem with gambling that has a negative impact on one’s life (APA, 2013). Individuals who engage in problem gambling tend to fall into four categories: those with low risk, those with moderate risk, and those with high risk (e.g., Problem Gambling Severity Index; Holtgraves, 2008).

Comorbidities such as anxiety, depression, and substance abuse disorder are common in “pathological gamblers,” according to a recent study. As many as 96% have one or more mental illnesses, and 64% have three or more mental illnesses,” the study found (Kessler et al., 2008). This situation is especially concerning in light of the current pandemic, which appears to be accompanied by an increase in anxiety and depressive symptoms (Rajkumar, 2020).

There have been a number of concerns about the pandemic’s effect on gambling since the beginning of the epidemic. In the wake of the closure of many land-based gambling activities, many actors fear a shift to online gambling as a result of the restrictions imposed by public health authorities, such as physical distancing and lockdowns (Davies, 2020; Griffiths et al., 2020; King et al., 2020). Because of its accessibility, speed, and anonymity, among other things, online gambling is considered a high-risk activity (Gainsbury et al., 2015; Hing et al., 2015).

It is the goal of this review to summarize the literature on the effects of the COVID-19 pandemic on gaming. Conducting a current assessment of the situation in order to guide public policies regarding gambling and reduce the harm associated with it is critical in today’s context. Langham et al. (2016) stated that “[h]armed from gambling is known to impact people, families and communities; theses harms are not restricted to people with gambling disorder.”

In the first phase of the outbreak, “total gambling activity decreased by 13.29 percent compared to [the] forecast,” according to Lindner et al. (2020). There was no increase in high-intensity gambling or total online gambling during the period studied, despite a significant decrease in betting and a slight decrease in online casino gambling. Only “four percent [4 percent] reported an overall increase in gambling during the pandemic,” according to Hkansson (2020). Hkansson et al. (2020b) found that “gambling increase during the pandemic was rare but [was] related to gambling problems” in their investigation of elite athletes. However, Donati et al. (2021) found that even problem gamblers decreased their gambling behaviors and cravings during the pandemic, and that no “shift toward online gambling and very limited shift toward other potential addictive and excessive behaviors” were found. According to Auer et al. (2020), “speculations that individuals may spend more time and money gambling online as a result of being confined to their home for long periods appear unfounded.”

COVID-19 pandemic’s risk factors for increased gambling behavior and problems are still unknown. Hkansson et al., 2020a, Hkansson et al., 2020b; Lindner et al., 2020) all found that the rare increases observed were always linked to high-risk gamblers. “Increased gambling was independently and clearly associated with the severity of problem gambling,” according to Hkansson (2020). Rather, Gainsbury et al. (2020) found that “individuals engaged in moderate-risk gambling, but not problem gambling, were more likely to report an increase in gambling frequency” during the pandemic, according to their findings. Personality and sociodemographic characteristics, such as “age, male gender, low levels of study, and impulsive characteristics play a decisive role in problem gambling” were found to be the most common causes of problem gambling during the pandemic.

There was no “conversion of money spent from sports betting to online casinos games […] and that frequent online sports bettors wagering on online casino games stayed the same before and during the COVID-19 pandemic,” as Auer et al. (2020) noted in regard to the feared shift to online gambling The minority of people who said they had switched to other forms of gambling had a “clear picture of problematic gambling involvement,” according to Hkansson (2020). The same conclusion was reached by him and his colleagues in another study (Hkansson, 2020b). “Although betting decreased substantially along with a slight increase in online casino gambling, there was no increase in high-intensity, likely problematic gambling,” according to Lindner et al. (2020). An older study (Lischer et al., 2021) found an increase in online gambling (p 0.002) among the population studied, while Hkansson (2020c) notes an important “increase in horse betting during the sports lockdown” and warns against a “possible COVID-19-related migration between gambling types, indicating a volatility with possible impact on gambling-related public health.”

According to four articles (Hkansson, 2020; Hkansson et al. 2020b; Price, 2020; Sharman et al. 2021) there is an association between gambling and well-known comorbidities like anxiety, depression and substance use disorder. Hkansson (2020) found that “the group reporting increased gambling had higher rates of psychological distress [and] one of the clearest findings of the study has been that self-reported increase in alcohol consumption during the pandemic is associated with a self-reported increase in gambling.” Study findings show that “gambling under the influence of alcohol or cannabis increased the odds of high-risk gambling status by approximately 9 times (p 0.01) […] and those who were screened for moderate and severe forms of anxiety (25.7 percent) and depression (12.6 percent) were more likely to gamble online during the first six weeks of emergency measures and be classified as high-risk gamblers.” Hkansson et al. (2020a) cited a pilot study conducted early in the pandemic at the Gambling Disorder and Other Behavioral Addictions Unit of the Department of Psychiatry at the University Hospital of Bellvitge in Barcelona, Spain, which found that “after two weeks of confinement, 12 percent […] reported worsening gambling […] 46 percent showed anxiety symptoms and 27 percent showed depressive symptoms” (Hka). According to Sharman et al. (2021), “mental health of participants; while depression stress and anxiety remain highest in potential problem gamblers,” lockdown had a significant impact on “the mental health of participants; while depression stress and anxiety remain highest in potential problem gamblers.” However, there was a significant increase in calls to other crisis lines, counterbalancing this decrease.

Damian Jacob Markiewicz Sendler: Several commentaries and editorials expressed concern that access to care and services for gamblers and support groups, such as Gamblers Anonymous, has been limited because of the pandemic (Turner, 2020; Yahya and Khawaja, 2020; Hkansson et al., 2020a; Yahya and Khawaja, 2020). According to Griffiths et al. (2020), COVID-19 is likely to increase the number of vulnerable people and worsen existing inequalities. Pandemic creates rare window of opportunity for treatment, detoxification, and rehabilitation of problem gamblers because there are fewer opportunities to gamble during lockdown, according to George (2020).

In response to the pandemic, some policymakers instituted new gambling restrictions. “The overall concerns about altered gambling behavior during the crisis have led several governments to take action through different measures, such as a limitation on gambling advertisements in Spain, deposit limits in Belgium, and a total ban in Latvia,” as pointed out by Hkansson (2020) in the introduction to his article. ” Legislation limiting online casino deposits and time spent gaming was passed by the Swedish government (Lindner et al., 2020). According to Hunt et al. (2020), evidence on the patterns and context of gambling in COVID-19 as well as its immediate aftermath is critical to alleviating gambling harms. There needs to be careful consideration of policies, say Gainsbury et al. (2020). Policy restrictions can lead to an increase in gambling activities that are known to exacerbate the problem.

Damian Sendler

Some authors have also briefly discussed the impact of the pandemic on the gambling industry. Indeed, the pandemic has had a significant impact on the gambling market. Driving through a drive-thru gambling center is an innovative business strategy used by some operators, according to Griffiths et al (2020). To be sure, the industry did exercise caution in some countries as mentioned by Sharman (2020). As a result of industry-led self-regulation initiatives, the most significant changes to gambling regulations in the UK have occurred. A ten-point pledge to promote “safer gambling” was made by members of the Betting and Gaming Council during lockdown, which was supplemented by a voluntary reduction in gambling advertising on TV and radio. Re-evaluation of the land-based gambling industry should be implemented during pandemic lockdowns by Czegledy (2020), according to Czegledy (2020). As a result of the pandemic, Ng Yuen and Bursby (2020) are concerned about the growing unpredictability in the gambling industry sector.

Gambling has become a public health issue in recent years, and policymakers and sports organizations have tasken notice. Certain sports, particularly football, were being separated from gambling before the pandemic occurred in Europe (Sharman, 2020). However, some football clubs were left in a precarious financial position due to the pandemic. Clubs’ dependence on gambling money was brought to light by this study (Sharman, 2020). It’s a concern to Griffiths et al. (2020) that governments may use gambling expansion and its subsequent revenues to recover resources that will be a priority with the inevitable economic depression looming, as this financial dependence on gambling money is.

Damien Sendler: There is a wide-ranging impact on gambling from the pandemic. It’s our understanding that this is the first review of COVID-19 and gambling specifically. From the beginning of the pandemic until February 25, 2021, the literature on gambling and COVID-19 has been reviewed. Preliminary findings suggest that gambling has declined overall since the outbreak of the pandemic, and that problem gamblers may be particularly vulnerable.

This review has a number of flaws that need to be addressed. Only peer-reviewed articles are included, and no gray literature is included. As a second point, six out of the original fourteen articles were written by Swedes (Lindner et al. ; Lindner et al. ), all of whom are from Sweden (Hkansson et al., 2021; Hkansson et al., 2020b). It’s impossible to generalize these findings to other countries because there was no lockdown in Sweden during the first wave of the pandemic (Warren et al., 2021) or because other countries didn’t impose gambling restrictions like deposit caps and time limits (Lindner et al., 2020). So, we need to be cautious about jumping to the conclusion that the pandemic hasn’t led to an increase in gambling. Gambling addicts appear to be at risk. In light of the current uptick in anxiety and depression symptoms, it’s critical to keep a close eye on this previously identified vulnerable population (Rajkumar, 2020).

Damian Jacob Sendler

There has only been a small amount of research done so far. There have been no published qualitative or mixed studies, in fact. It is critical to gain a better understanding of how gamblers coped with the pandemic. Gambling may have decreased as a result of a number of factors, including individuals having less money to gamble because their occupational earning potential has been lower during the pandemic, individuals not wanting to gamble in front of their family members, or individuals spending more time on other activities such as spending quality time with their families or finally having the time to do bigger jobs around the house and gar. We need more information about these hypotheses in that context. Furthermore, studies on specific populations, such as the LGBTQ+ community and Native Americans, are lacking. Finally, as outlined by Hkansson et al. (2020a), comparative studies on gambling policies adopted during the pandemic, the impacts of COVID-19 on the gambling industry, and alternative forms of gambling developed by gamblers, such as teenage football games or amateur low-tier friendship games, are needed.

Be aware that the scope of this review extends only as far back as February 25th, 2021. As a result, there are more studies that focus on the first wave of the pandemic, rather than the second or third. We need studies that look at the effects of the pandemic as a whole, as well as subsequent waves. To get a more complete picture of the issue, studies from around the world are also needed. Further research on gambling and COVID-19 will be necessary by the end of the pandemic, given how quickly the literature is evolving. “Even in the midst of the pandemic, we need to be aware that gambling harms are still occurring,” according to Griffiths et al. (2020).

As a result of the COVID-19 pandemic, problem gamblers, as well as others, are particularly vulnerable, according to the current literature. As the pandemic continues to ravage the world, more research is needed. Because of the evolving context in which the pandemic is taking place, unanticipated consequences, impacts, and reactions are possible. Various methodology designs and a focus on various populations and regions are needed for future research in order to better understand the impact of the COVID-19 pandemic on gaming. The most vulnerable people will need their assistance if we are to reduce the negative effects of gambling.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Some studies show an increase in adolescent substance use during the COVID-19 pandemic; others show a decrease in binge drinking and vaping; and still other studies show no change. Only 8.3 percent of the 1.1 million adolescents with a substance use disorder sought outpatient treatment in 2019. As of this writing, 2020 treatment rates have not been released. Many outpatient substance abuse clinics were forced to close in March 2020 due to stay-at-home orders and social distancing guidelines. Considerations for working with adolescents during stay-at-home orders are discussed in light of this treatment suspension.

Damian Jacob Sendler: When it comes to social and emotional maturation, the adolescent years are critical. At this stage, it is crucial for children to establish their social identities, gain emotional and personal independence from parents and other caregivers, and begin the process of becoming self-sufficient. 1 As a result of the COVID-19 (coronavirus disease of 2019) pandemic, this process has been completely upended and thrown off balance. For the past three months, most teenagers have been unable to attend school, interact with their peers, or participate in sports and other extracurricular activities in person. Prom, graduation, and heading off to college have all been omitted as traditional life milestones. When their parents were at work, many teenagers were forced to take on the responsibility of caring for their younger siblings. Since students must spend so much time in front of screens, it can be difficult to stay motivated and interested during their time in distance learning. Teens are used to spending most of their time with friends, teachers, and coaches. Sheltering in place is a huge change for them. Adolescence’s crucial individuation process may be slowed by the lack of routine and few opportunities to take healthy risks or express developmentally appropriate independence. 2 Because of the pandemic’s effect on isolation, uncertainty, and fear and the heightened risk of substance use disorders among a new generation of adolescents, it is not surprising that depression, anxiety, stress, and boredom have increased.

Dr. Sendler: The use of alcohol, LSD, over-the-counter cold and cough medications, and heroin increased slightly from 2019 to 2020. Annual surveys on substance use have also been affected by the pandemic, so it’s unclear if these changes are connected to the COVID-19 pandemic. The MTF, for example, is typically administered between February and May, with results made public later in the year after administration. Only one-quarter of the usual sample had completed the survey in mid-March 2020 because of the pandemic. 8 There has been a decrease in the number of people using e-cigarettes to smoke nicotine and marijuana, according to data from 2020, which is considered nationally representative. Cocaine, MDMA, and heroin use among twelfth graders remained at a low level. Until the results of this year’s MTF survey are made public at the end of 2021, it will be impossible to predict whether these patterns will persist throughout the pandemic.

Alcohol, tobacco, and illicit drug use are all well-documented in the National Survey on Drug Use and Health (NSDUH). 13.2 percent of 12–17-year-olds reported using cannabis in the past year, and 9.4 percent reported using alcohol in the past year, according to the 2019 survey results. 9 In 2019, 1.4 million teenagers began using cannabis for the first time, which works out to 3700 new users every day. NSDUH and MTF surveys have different methodologies and different age groups, which results in different overall use rates (ie, the NSDUH groups 12- to 17-year-olds together and puts 18-year-olds, who generally have high rates of use, in an 18- to 25-year-old group, whereas the MTF groups by grade level). An additional disadvantage of interviewing teens in their homes is a potential underreporting of drug use. 10 It won’t be until fall of 2021 that the NSDUH 2020 results are published.

Despite the lack of data, it appears that the stress and isolation caused by months of lockdown and social distancing has led to an increase in adult substance use.

8 The Centers for Disease Control and Prevention found that 10% of 18-24-year-olds in their sample of 5412 online survey respondents increased their substance use in the past month (the survey was completed in June 2020), with the greatest increases observed at the younger ages of the cohort. 11 However, teens under the age of 18 were not included in this study. Only a few studies have examined the impact of the pandemic on young people’s substance use, including an online survey in Canada and an online survey on vaping from Stanford University. The aforementioned 12 to 14 These studies show that the pandemic’s effect on adolescent substance abuse is not yet clear.

1054 Canadian teenagers (aged 14–18) were surveyed online about their alcohol, cannabis, and e-cigarette use in the three weeks leading up to and the three weeks following the start of the COVID-19 stay-at-home orders. Overall, fewer teens reported binge drinking, vaping, or using cannabis after COVID compared to prior to COVID, and alcohol use remained stable. ‘ In contrast, among those teens who did use substances, the mean number of days they drank alcohol (0.76–0.96 days) and smoked marijuana (0.94–1.1 days) increased significantly after COVID.12

Intriguingly, usage patterns shifted following the introduction of COVID. Solitary drug use was the most common mode of consumption for these respondents (49 percent), followed by social media (42 percent), and face-to-face interactions (32 percent) (24 percent ). This finding is surprising given the prevalence of adolescent substance use as a highly social behavior. Increased anxiety about COVID-19 and depressive symptoms were both linked to solitary use. Adolescents may use substances as a means of coping with pandemic-related stress and isolation, according to researchers. 12 Teens are more likely to use drugs to cope with stress and more likely to use them alone than previously thought. (15) and (16) In light of the link between teen substance use and poor mental health, these new use patterns are particularly concerning. 17

Also distressing is the fact that 26% of the teens who reported drinking with their parents reported binge drinking, which is a significant number. As a known risk factor for risky substance use,18 parents who engage in this behavior are also likely providing their teens with alcohol. When drinking with their parents, teens are more likely to use alcohol in moderation. However, when drinking alone, they are more likely to use alcohol in high-risk ways. 19 and 20

As a result of this social distancing, it is not surprising that teens would engage in substance use with their peers via video chat or post photos of themselves engaging in substance use on social media. Finally, 24% of teens reported using substances in front of their peers, despite emergency stay-at-home orders, which is alarming. The study does not indicate if parents were aware of or allowed their children to engage in social interactions with their peers. As a result, it is possible that adolescents were more willing to put their health at risk because of their lack of knowledge about the dangers of severe coronavirus symptoms. These preliminary findings on COVID-19-related substance use trends may not be conclusive because the study was conducted so early in the pandemic that usage patterns may not have yet been established.

The pandemic has been linked to a decrease in substance abuse in other studies. Vaping rates may have fallen because of fewer commercially available and easily accessible vape products, according to some research. 20 In May 2020, two months after the stay-at-home orders were issued, a survey on self-reported vaping habits was conducted. Nearly three-quarters of the 1442 participants ages 13 to 24 who used e-cigarettes reported reducing or quitting their habit in the two months since the pandemic began. Concerns about lung function, the inability to purchase products, and anxiety over parents finding out were cited as some of the reasons for this shift. Because most teens get their e-cigarettes from friends or brick-and-mortar retail stores rather than the internet, stay-at-home orders that shut down vape shops and reduced social contact prevented many teens from getting their e-cigarettes from stores or friends, resulting in lower rates of vaping. 21

In the first two weeks following the closure of non-essential services in Canada, an online survey of 622 youth and young adults in established clinical and community settings found that social distancing may have contributed to a decrease in substance use.

13 A lack of data on the types of substances used, the frequency and quantity of use, and the findings were not reported by age groups was a major drawback.

For now, even in these extraordinary circumstances, we can use well-known risk and protective factors for substance use to anticipate and plan for future needs for treatment even if the effects of the pandemic are not yet fully understood. These include factors such as drug availability, a lack of parental supervision, boredom, and the ability to deal with negative emotions, among others, which have been shown to increase a person’s likelihood of using drugs. Protective factors include parental monitoring, lack of negative peer influence, academic success, and strong family and community ties.. In spite of the pandemic’s potential to increase substance use among adolescents, it is possible that pandemic-related restrictions will reduce known risk factors and reduce substance use. , 22, 2

The COVID-19 pandemic has undoubtedly disrupted daily life and raised stress and anxiety levels in adults and adolescents alike. Due to an increase in adult drinking during the pandemic, teens may be more exposed to their parents’ alcohol use, which could lead to easier access to alcohol and other drugs in the home. 23 Teenagers who have a wide variety of substances available to them at home may be more likely to engage in substance abuse. In the United States, 87% of reports to poison control centers in 2019 involved exposures in the home among individuals aged 13 to 19. A wide range of prescription and over-the-counter medications, as well as illicit substances like cocaine and methamphetamine were found to be the most common substances these adolescents were exposed to. Nearly two-thirds of those who were exposed did so knowingly. 24 Stress-relieving substances are more likely to be used by teenagers if they see their parents using them to cope with stress, manage negative emotions, and cope with social isolation. Furthermore, older siblings in the home may also facilitate younger siblings’ use by co-using or giving their younger siblings access. 22 Other possible causes for the post-COVID rise in alcohol and cannabis use among adolescents include an increase in unstructured time due to asynchronous remote learning and a lack of extracurricular and other leisure activities, and also social isolation, boredom, and life stress. Four and twenty-five

The pandemic, on the other hand, appears to have a lower risk of substance abuse because of a variety of factors.

2 The more time parents spend with their children at home, the lower their risk of injury or death is likely to be. Parents and caregivers are likely to be more aware of their children’s activities, which may reduce the likelihood of them engaging in unhealthy behaviors like substance abuse. It is possible that having parents and caregivers at home most of the time could reduce binge drinking and the use of vaping products and other substances by teenagers, as well as curtail activities that encourage binge drinking, such as parties. 26 It’s also important that teens who have been placed on home-detention have fewer opportunities to hang out with their peers who are engaging in risky behaviors like drug use, as socializing with other drug users is a major risk factor. 27

Remote or hybrid learning is less stressful for teenagers who have experienced academic or social pressure at school. Teens who take drugs to cope with stress and negative affect may have used less as a result of the lessened stress. Furthermore, because remote learning does not necessitate early morning starts, sleep deprivation, a risk factor for substance abuse, is minimized. 2

Teens who have not yet started using drugs or alcohol may be delayed in their use due to fewer opportunities to engage in risky behavior or restricted access to alcohol and drugs because parents are at home and social distancing. Given the effects of drugs on the developing adolescent brain, prevention strategies focus on delaying the onset of substance use. 28 Adults who begin using drugs or alcohol at a young age are more likely to develop an addiction later in life. 29 To put it another way, social isolation may be reducing the likelihood of future substance abuse.

COVID-19 seems to affect young people less frequently than it does the elderly, but it is unclear whether substance abuse or a substance use disorder increases a person’s susceptibility to coronavirus transmission or the likelihood of a severe infection being contracted.

30 Immune, pulmonary, and respiratory function can be compromised as a result of alcohol and other drug use, making it more difficult to fight off infection. It’s either 31, or 32. The immune system can be affected by alcohol consumption, which can lead to chronic weakening of the lungs, increasing the risk of pneumonia. 33 Drugs that cause vasoconstriction, such as cocaine and methamphetamine, are dangerous because they can harm the lungs and cardiovascular system. Opioids can slow breathing and cause hypoxia at high doses, putting the user at risk of an overdose and death. Even adolescents may be at risk of severe illness from COVID-19 if they smoke or inhale drugs such as nicotine or cannabis, which can worsen respiratory conditions such as asthma. Smoking and vaping, according to new research, can irritate, inflame, and damage the lungs, raising the possibility of contracting a virus. In order, 34, 35 and 36. Young people who smoke or use e-cigarettes are at greater risk of developing coronavirus-related illnesses, such as pneumonia or acute respiratory distress syndrome (ARDS). Viral transmission can be exacerbated by the habits associated with smoking or vaping. Vaping, for example, can cause a person to exhale quickly and loudly, making it impossible for them to wear a face mask while doing so. Aside from sharing blunts, joints, and vaporizers, smoking and vaping habits often include the sharing of these items, which increases exposure. 37

Using a population-based, cross-sectional online survey, Gaiha and colleagues14 investigated associations between COVID-19 and e-cigarette use. It was found that youth who used e-cigarettes were 5 times more likely than nonusers to contract COVID-19 illness, and youth who used e-cigarettes and tobacco cigarettes together were 7 times more likely to contract the illness. The survey included 4351 adolescents and young adults (aged 13–24). 14 Smoking and vaping have been linked to an increased risk of COVID-19 illness, which makes it imperative that health care providers screen all young people, including those with COVID-19 infection, for cigarette and e-cigarette use.

Damian Sendler

Adolescents in the United States had a significant increase in the number of those who met diagnostic criteria for a substance use disorder in 2019, according to the most recent NSDUH data.

38 There has been no significant increase in the number of adolescents seeking treatment for a substance use disorder despite the fact that more of them are abusing substances. This survey found that only 8.3 percent of these adolescents had received treatment for substance abuse in the preceding year. 38 98.5 percent of those who didn’t receive any treatment said they didn’t need it, even though they met the criteria for a substance use disorder diagnosis (Substance Abuse and Mental Health Services Administration, 2020). 38 As a result, when selecting an intervention for a particular adolescent with a substance use disorder, clinicians must take their needs and motivation into account. Adolescents with varying levels of need and readiness for treatment can benefit from the following research-based treatment approaches for substance use disorders.

All of these approaches to treating substance abuse have been found to have strong research support by Division 12 of the American Psychological Association, including cognitive behavioral therapy, motivational interviewing, contingency management, and motivational enhancement therapy. Both the adolescent community reinforcement approach (A-CRA), as well as 12-step facilitation therapy, have been approved by the National Institute on Drug Abuse (NIDA). 39

Damian Jacob Markiewicz Sendler: Adolescents who are struggling with substance abuse can benefit greatly from cognitive behavioral therapy (CBT). By using cognitive behavioral therapy, therapists hope to help young people anticipate and prepare for situations where they may be at risk of substance abuse. 39 As part of MI, the therapist acts as an intermediary between the patient and themselves, facilitating the patient’s desire for and commitment to change. Adolescents who are on the fence about abusing drugs or alcohol may benefit the most from this approach. 40 Based on MI principles, motivational enhancement therapy incorporates feedback from an individual’s assessment of their progress. This therapy is designed to help adolescent drug addicts develop a motivation and desire to participate in treatment. Motivational Enhancement Therapy (MI) and Motivational Enhancement Therapy (MET) are typically used in conjunction with Cognitive Behavioral Therapy (CBT). 39 and 40, respectively

In order to reduce substance abuse, CM employs the principles of reinforcement. In the majority of cases, CM for substance abuse involves monitoring drug use behaviors and rewarding desired behaviors (such as treatment participation, meeting specified goals, not using drugs, etc.) with tangible rewards. Psychosocial treatments like CBT and EMDR are often combined with CM to achieve the best results. 39 and 40, respectively

It is a treatment that aims to replace the positive reinforcements for substance use in the patient’s life with more effective social, educational or vocational reinforcements. Another goal of 12-step facilitation therapy is to increase the likelihood that adolescent substance abusers will join a 12-step program like Narcotics Anonymous.

Adolescents’ families are a part of their substance abuse treatment in family-based therapeutic interventions. Adolescent substance abuse, family conflict, co-occurring disorders, and academic difficulties are all addressed in these methods. Adolescents may benefit from interventions that involve their families because they are likely to live with at least one parent or guardian. 39

Family-based interventions have been shown to be effective in the treatment of adolescents’ substance abuse.. Problem behaviors are seen as the result of dysfunctional family interactions, and the goal of brief strategic family therapy is to change those patterns of interaction. Family behavior therapy combines the principles of CM and behavioral contracting to reduce problem behaviors, such as substance abuse, in the family unit. Problem behaviors are seen as responses to unhealthy family functioning, and behavioral techniques are used to enhance family communication and problem solving. CM principles are also incorporated into functional family therapy. 39

Adolescents with substance abuse issues can benefit from multidimensional family therapy, which integrates family and community resources. Adolescents and their families can work together more effectively in school and the justice system when they have access to multidimensional family therapy. ‘Multidimensional family therapy’ is frequently used to aid in the reintegration of juvenile offenders back into society. Furthermore, multisystemic therapy incorporates family and community-based interventions into its practice. The adolescent’s substance use is not only viewed from the perspective of the adolescent and their family, but also from the perspective of peers, school, and neighborhood characteristics.

Outpatient treatment was preferred by the vast majority of adolescents receiving treatment for a substance use disorder in 2019; only 9.1 percent received nonhospital inpatient care, and 1.3 percent received inpatient care at a hospital setting.

38 These percentages are consistent with data from reports dating back to 2009 and continuing through 2017. Adolescents who are receiving treatment for a substance use disorder in outpatient facilities are expected to remain the most common mode of care in 2020.

Many outpatient substance abuse clinics experienced partial closures and were forced to suspend certain types of treatment following the March 2020 stay-at-home orders and social distancing guidelines. As a result of social distancing, group therapy may have been halted or moved to online formats such as video conferencing. Adult patients with substance use disorders may benefit from telehealth interventions, according to new research. Telehealth services for substance use disorders are now available through the Houston Emergency Opioid Engagement System (HEROES). Initial studies show that this system has maintained patient engagement and even seen an increase in attendance at some virtual recovery group meetings with this system in place. 41

Damien Sendler: Some other researchers have been working on developing various digital platforms to help those with substance use disorders, such as RAE. (Realize, Analyze, Engage). RAE is a wearable device that measures biomarkers of stress and craving as part of a digital treatment for substance use disorder. Dialectical behavior therapy interventions are also included in the platform, as is a connection to a clinician when assistance is needed, as well as a clinician-facing portal for transferring client data to a treatment team. Throughout 2021, clinical trials will be conducted to better understand the platform’s efficacy. 42

It’s important to keep in mind that only adults were used in these studies. Telehealth services for adolescents with a substance use disorder may have unique considerations. Adolescents, unlike adults, typically live with a parent or guardian and other members of their family, which can limit their privacy. Adolescents may be reluctant to open up to health care workers if they fear that their conversations will be overheard by family members. According to the National Survey on Drug Use and Health, one in eight children in the United States lives with a parent or caregiver who has a substance use disorder. 4 and 43 In the case of a parent with a current substance use disorder, a child may feel particularly uneasy about receiving treatment in their own home because of their parent’s history of substance abuse. When working with a young person experiencing homelessness, the lack of access to face-to-face outpatient services can make it difficult for service providers to connect them with the community resources they need. Instead, adolescents may be reluctant to seek treatment in person because they fear exposure to COVID-19.

Damian Jacob Sendler

In the event of a COVID-19 pandemic, adolescents who belong to high-risk groups may face additional difficulties in receiving treatment. The pandemic appears to have worsened the lives of impoverished and homeless youth, for example. Many of these adolescents may not be able to access telehealth services because they lack internet, phone, or computer access. Mental health and substance abuse treatment may be harder to access if in-person services are discontinued and fewer people are admitted to community service providers and shelters. Homelessness/poverty and substance abuse disorder both put these adolescents at increased risk for COVID-19 infection, but the lack of treatment may lead to an increase in risky behaviors to obtain substances. 44

As a result of the pandemic of COVID-19, LGBT youth may be at a higher risk of contracting the disease. LGBTQ adolescents are more likely to be physically and sexually abused, and stay-at-home orders may inadvertently increase contact with abusers in the home. Having an abuser in the home is likely to decrease telehealth treatment involvement for those adolescents. This risk, coupled with the possibility of increased victimization, may lead to an increase in the number of LGBTQ adolescents abusing drugs and alcohol,44

Finally, the opioid crisis has not spared our young people. Prescription opioids, heroin, and fentanyl overdose deaths among under-20-year-olds increased by 95 percent, 405 percent, and 2925 percent, respectively, between 1999 and 2016. 45 During the COVID-19 pandemic46, an increase in opioid overdoses has been observed among Black Americans, according to recent findings. 47 Nonfatal opioid overdoses have also increased dramatically since the pandemic was discovered in March 2020, according to data collected by the Centers for Disease Control and Prevention48 from more than 42 states. Since their peak in May of this year, heroin overdose rates have been steadily declining, though in September of this year (the most recent month for which data is available), they were still higher than they were for almost the entire year of 2019. Pre-pandemic 2020 and any month of 2019 saw a slight decrease of nonfatal opioid overdoses in July and August, respectively, but September saw a higher rate than any other month in 2019. 48 Adult and adolescent opioid overdose rates increased significantly in the pre-pandemic years, despite the fact that these COVID-19–related findings did not separate the two groups. According to the data from COVID-19, fatal and nonfatal opioid-related overdoses among adolescents have increased significantly. Some of the reasons for the rise in opioid overdoses include treatment interruptions, an increase in mental health stressors, and a rise in the prevalence of lone substance use, which reduces access to help.

Treatment providers may benefit from preparing for an increase in the number of adolescents who need treatment for a substance use disorder as services begin to return to in person following the pandemic of COVID-19. Pregnant women, children, and adolescents should be screened for substance abuse during routine checkups by their pediatricians and primary care providers. 4 Even adolescents who do not meet the criteria for a substance use disorder may benefit from some substance-related treatment, so clinicians providing general psychological services to adolescents should consider including some type of substance-related programming. 39 Due to barriers to telehealth treatment, treatment providers who serve impoverished, homeless, or LGBTQ adolescents may see an increase in demand for in-person services.

In the meantime, families and clinicians can help adolescents with substance use disorders. For parents and caregivers, a stay-at-home order offers a unique opportunity to establish and maintain order in the household. For example, they can implement a morning routine, encourage family bonding activities, and promote open, nonjudgmental communication within the home to assist adolescents in their recovery efforts. Adolescents should also be monitored by parents and caregivers for signs of substance abuse or withdrawal. According to J. Wolfe, parents and caregivers should report any signs of substance abuse to health care professionals. Adolescents who are socially isolated may have difficulty controlling their emotions or experience extreme mood swings as a result of both withdrawal and continued substance use. Adolescents who attempt to isolate themselves at home may be trying to conceal their drug-seeking or drug-using behaviors. A person may isolate themselves by sleeping all day, locking themselves in their room, or simply avoiding contact with family members. The adolescent’s repeated arguments about leaving the house to be with friends or sneaking out behavior may also indicate that the teen is attempting to obtain or use substances. It’s also possible that an adolescent or their room smells strangely, which could be an indication of ongoing substance abuse. Skunk-like aromas can be found in the smoke of marijuana, for example. The use of a vape or the consumption of sweet drinks mixed with alcohol can result in a sweet aroma. The use of air fresheners, perfume or cologne to mask the odor of substances may also be used as a cover-up tactic. You may want to talk to your pediatrician about possible treatment options if you’re concerned about your teen’s substance use.

Adolescents with a substance use disorder can benefit from remote treatment if the provider makes an effort to check in with them about their safety and any difficulties they are having at home. Health care workers should also encourage adolescents to seek out a private location from which to conduct remote treatment if possible. While following social distancing guidelines, treatment providers should consider resuming in-treatment services if adolescents cannot openly discuss problems they are experiencing because of lack of privacy or fear of safety (ie, staying 6 feet apart, wearing masks, and washing hands and surfaces).

Tobacco cessation, including smoking and e-cigarette use, may also be a focus for health care workers during this time. Due to stay-at-home orders, adolescents may have more difficulty obtaining various substances, such as cigarettes and vapes. So treatment providers can use this time to increase motivation for quitting and doctors or other health care providers may prescribe nicotine replacement treatments for adolescents who are experiencing cravings or withdrawal symptoms. 50 More and more AA and NA meetings are being held online, as well as other 12-step support groups like Alcoholics Anonymous and Narcotics Anonymous. In addition to providing information on how to find and join a virtual meeting, their respective websites now feature entire pages dedicated to virtual meetings. It may be beneficial for adolescents who have experienced a break in their in-person treatment to receive this kind of support.

We can gain insight into how the COVID-19 pandemic affects adolescent substance use by examining its various effects on adolescent use of substances. Social isolation and boredom appear to increase the risk of substance abuse in pandemic-related life changes. Other changes, such as increased family time, parental monitoring, and reduced access to substances, appear to reduce the risk.

As the pandemic spreads, longitudinal studies are needed to track changes in teen substance use patterns over time, as well as mental health outcomes associated with those patterns. The long-term effects of school closures, remote and hybrid learning, social distancing, and quarantining should be examined, given the important role that peer pressure and social group dynamics play in determining teen drug use and experimentation. Research is also needed to determine whether or not the pandemic has resulted in an increase or decrease in the use of drugs by teens and members of their families.

A study by Sumas and colleagues in the early weeks of the pandemic should also look at parental permissiveness, which allowed parent-teen drinking and binge drinking behavior.

Parents may have relaxed some rules during the shutdown, perhaps deeming it safer for their teens to drink with their parents than to go out and drink with friends, but this co-use drinking behavior may have long-term consequences because parental permissiveness has been linked to higher rates of substance use.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: It’s time for a paradigm shift to a more holistic, community-based approach to health care, as illustrated by the healing wheel, in light of the COVID-19 pandemic. According to this study’s findings, existential positive psychology (PP 2.0) holds great promise for meeting the escalating demand for palliative care. An important part of this framework is focusing on how we can cultivate our spiritual and existential capacities in order to achieve personal growth and flourishing, as well as how to transcend and transform our own suffering. Dialectical palliative counseling, as demonstrated by Wong’s integrative meaning therapy and the Conceptual Model of CALM Therapy in palliative care, can accomplish both of these goals at the same time. After that, we’ll go over the goals of treatment and the methods used by IMT when providing palliative counseling to people in hospice or receiving palliative care. According to our review of recent literature, as well as our own research and practice, PP 2.0’s hypothesized foundation for healing and well-being is indeed existential suffering in general and at the end of life in particular. Palliative medicine should also be holistic, which means that patients’ inner spiritual resources should be nurtured as well as the support of their families and the wider community, as symbolized by the healing wheel.

Damian Jacob Sendler: With over 4 million deaths and 100 million confirmed cases, the COVID-19 pandemic has revealed the deficiencies of palliative care. Even palliative care workers have faced serious challenges like a lack of beds and staff and long working hours [1,2,3]. Personal protective equipment has also been a problem for all healthcare workers. Palliative care should be integrated into COVID-19 management and optimized for the pandemic, as demonstrated by the situation in Toronto [4]. Increased life expectancy and an increase in psychological needs, such as meaning for living, the will to live, and acceptance of death, necessitate a strategic approach to palliative care [5,6,7]. People who are nearing the end of their lives are particularly vulnerable to the existential crisis.

Dr. Sendler: Companionship is the best medicine for those who are nearing the end of their lives. Compassionate care requires doctors to accompany their patients in their pain rather than merely being experts who tell them what to do.” [8]. Byock [9], a leading US palliative care physician, wrote: “We are at our best when we serve each other.” A philosophy of “fighting disease and illness at all costs” should not be the driving force behind the healthcare system, he said. When it comes to providing the best possible care for the elderly, we must not only restructure our healthcare system but also overcome our cultural aversion to discussing death.

When I think about the current pandemic, it brings back memories of the SARS crisis, whose failures exposed the ineffectiveness of the well-entrenched biomedical model of healthcare. The compassion, self-transcendence, and existential courage that frontline healthcare workers and volunteers demonstrated in my keynote on compassion, funded by the Hong Kong medical authority [10], demonstrated the crucial role of the spiritual dimension.

My holistic model (see Figure 1) aimed to improve healthcare services without increasing costs in a corresponding manner by drawing on spiritual resources. The historic Alice Ho Miu Ling Nethersole Hospital, where I delivered my speech in Hong Kong, served as a metaphor for a holistic healthcare system that is rooted in spirituality. “To bring Life to Mankind in its fullness through Enhancement and Compassionate Care for the Sick” has been Nethersole Hospital’s mission statement for more than a century, and they have consistently provided quality care to the residents of Hong Kong.

Even today, the Healing Wheel is still relevant. Healers (healthcare providers) need a spiritual connection with God (or a higher power) and a set of religious beliefs or rituals to be their best. It is their responsibility to serve as a spiritual conduit for others. They will have an impact on their patients and the medical community because of their love and faith. It is as if they are interceding for the patients’ well-being as they minister to them.

In a supportive and caring environment, compassionate human encounters can be a powerful source of healing. Healing is a way for healers to give back to those in need while also serving their own personal god or gods. It is through the compassionate care that the patients rediscover the meaning of hope and love. Volunteerism and compassion are a blessing to the community, not just for the patients, but for the volunteers themselves.

It is best to view the above holistic healthcare model through the lens of existential positive psychology (EPP), also known as positive psychology 2.0 (PP 2.0) [13], as opposed to Seligman’s original positive psychology [14]. Existentialism and positive psychology both emphasize the importance of happiness and well-being as the ultimate goals of life. Since EPP encompasses both our positive and negative sides, it promotes growth in character as well as well-rounded contentment. EPP’s main goal is to make a positive impact on all aspects of one’s life in order to complete the circle of health and happiness [15,16].

Resilience and flourishing through transforming suffering is explained in the above model. It’s important to remember that life isn’t always a smooth ride because of our inherent flaws and foibles, as well as the inevitable suffering that occurs at every stage of human development. Suffering is an inevitable part of life in many cases. Even though medical or cognitive models may be able to alleviate some forms of suffering (such as pain), there is no guarantee that all forms of suffering can be eliminated. As a result, they cannot be eliminated by pursuing happiness, since the pursuit itself may be a source of pain from greed and disappointment. Positive psychology’s emphasis on chasing happiness doesn’t work in a pandemic, for this reason. As a second part of this new paradigm, the approach and avoidance systems work together, any setback in the pursuit of happiness will activate the aversive system, and in coping with inevitable suffering, we are able to transform it into strength and joy through personal growth. When we embrace suffering instead of running from it, we give ourselves a better chance of overcoming the obstacles we face on our path to happiness.

For existential positive psychology, all emotions—even the painful ones—are beneficial because they help us build our resilience, meaning, and well-being. [13,14]. Death, in a strange twist of irony, holds the key to a full, rich, and fulfilling existence [22]. Although death’s physicality can destroy us, the concept of death has saved many lives, according to Yalom [23]. For PP 2.0, the challenge is how to transform fear of death into acceptance of death, a meaningful life, and mature contentment.

The dual-system model [20] offers the most insight into the positive psychology of death anxiety. This model states that the best way to adapt is to face and transform the negative aspects of life in order to achieve the positive ones. Indeed, a strong offense is the best form of defense. Despite the looming threat of death, the best defense against the paralyzing fear of dying is to devote our lives to something worthwhile. If we are ever going to free ourselves from the shackles of death fear, both the approach and avoidance systems are necessary. Death fear and death acceptance can coexist and contribute to our well-being when viewed from this dual-systems perspective.

Spiritual resources can be developed in order to restore a lasting sense of calm and equilibrium in order to avoid emotional rollercoasters and getting stuck in the dark pit of painful memories and emotions. The central point of intersection of all possible human dimensions, both horizontally and vertically, is the best representation of such mature happiness. It’s possible to be happy in any situation, regardless of our ethnicity or religious beliefs [25,26].

An inner sanctuary of serenity and spiritual blessings awaits those who find themselves here. Symbolically, it represents the paradoxical truth that one must go through Hell in order to get to Heaven, and one must lose oneself in order to find others [27]. There are examples of this mature happiness in Jesus Christ, Buddha, and Lao-tzu.

The dual-process model underpins numerous palliative therapies. Cancer and Living Meaningfully (CALM) in palliative care, for example, aims to help patients cope with both their emotional distress as well as their desire for growth and wellbeing. To help the patient cope with their illness/symptoms, CALM sessions focus on helping them maintain a sense of significance and purpose. As Reed’s theory of self-transcendence points out, vulnerability to suffering must be turned into personal growth and well-being through self-transcendence [30,31].

Every stage of life, from childhood to adulthood, presents both an existential crisis and an opportunity for personal development. To Erickson’s stage model [32,33], this model adds an existential positive psychology dimension to the stages of adult development. Consequently, life is seen as an all-out battle at every stage of human growth. How we handle our current crises may determine whether we live a life of virtue and flourishing or a life of pain and suffering as a result of the bad decisions we’ve made in completing our developmental tasks.

Our ancestors’ “Why?” cries could be heard in my mind: Why has my child been kidnapped by a beast? What makes God so enraged, and why do we suffer as a result of his wrath? Why is it so difficult to live? What’s the point of putting up a fight if we’re all going to die? Life is full of suffering and existential crises at every stage of human development, so he has never stopped searching for meaning.

At some point in their lives, all of us have asked ourselves, “Who am I?” What am I supposed to be doing here? What am I supposed to do with my entire life? What is the most important thing to me? What and where can I do in order to be happy? Can you give me some tips on how to steer clear of making poor life choices? Where do I fit in? What is the location of my permanent residence? All of this effort is for nothing. What am I?

Self-evaluation and regret are more prevalent in the lives of the elderly [23,35,36]. Is my life what I envisioned it to be? Is it even worth living? The point of suffering is lost on me. What’s the point of dying, anyway? In the afterlife, what happens to me? Forgiveness can be found and given, but how do I go about doing so? What should I do with the rest of my life? In the face of impending death, how can I find solace, solace, and hope?

Each and every cry for meaning serves the dual purpose of making pain bearable and finding a reason to live, thus increasing our likelihood of moving towards a life goal despite difficulties and suffering. Real-life encounters with human evil, suffering, and death often come as a surprise to those going about their daily routines.

To answer the “Why?” questions, people will have to look for a reason or purpose for their existence. One does not need to understand or use the word “meaning” to live a meaningful life. Human nature and the facts of life combine to make us yearn for a richer, more meaningful existence.

For Peterson [37], religiousness and spirituality are essential for human survival in a world full of perils, wrongdoing, and ambiguity. Heroism in the face of widespread evil comes primarily from everyday heroism of taking responsibility for making the necessary sacrifices and aiming for some greater good. In Peterson’s view, evil and significance are connected by a mechanism that evolved to protect us from our own inherent vulnerability as finite beings in the face of immeasurable power.

Existential crisis becomes more intense at the end if people haven’t dealt with their issues early on, as vividly depicted by Tolstoy in his novel [38]. Ivan Ilyich’s death. When Ivan finally realized that his life was not what it should have been in the midst of his mental and physical anguish, he was spiritually reborn. He discovers the meaning of life and relief from suffering only after he resolves to make amends to his wife and apologize for his actions. Before he dies, his heart is filled with joy.

Akira Kurosawa’s classic film Ikiru is another example [39]. It’s not until cancer strikes Watanabe’s character that he begins to contemplate the meaning of life in this film. Rather than dwelling on her impending death, Ikiru shows us the triumph of a life well-lived. A cesspool was transformed into an amusement park thanks to the sacrifice of Watanabe and his happy death. Following his cancer diagnosis, he began the process of a good death by attempting to find meaning in his final days.

Damian Jacob Markiewicz Sendler: When it comes to medicine, logotherapy is a supplement, according to Frankl [40]. Patients often ask themselves, “Why me?” or similar existential questions. Why is this happening now? Why do we have to go through this? Why am I being taken from this world at such a tender age? People experience existential pain when they can’t come to terms with the enigmas of evil, pain, and death.

Existential distress is measured by the Patient Dignity Inventory (PDI) [48] and includes items like “Not feeling worthwhile or valued” and “Feeling life no longer has meaning or purpose,” while peace of mind is measured by items such as “needing future meaning, meaningful contribution, and spiritual life.

Damian Sendler

As a result, resolving these existential conflicts is critical to the well-being of palliative care patients. Three factors in the subscale of spiritual well-being, according to the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being [49], depict mature happiness in terms of inner peace and harmony due to spiritual beliefs, faith, reasons for living, and sense of purpose.

Palliative care patients face existential anxieties on a daily basis as they near the end of their lives, and recent research has shed light on this issue. There is no doubt that these fears have many facets [59] and are the cause of a great deal of misery [60]. Although they have been studied, they are still largely ignored in palliative care research and discussions [61].

Existential anxieties can have a significant impact on the level of distress palliative care patients experience. For example, older age, higher spiritual well-being, attachment security, and meaning in life are all associated with less distress [62,64,65]. Existential anxiety is a common problem among palliative care patients, their loved ones and caregivers, according to previous research. We’ll go over a few of these concerns now.

Many people have anxiety about death, which can range from practical concerns (such as how they will die or whether they will be a burden to their caregivers and family) to more existential ones (such as what will happen to them after they die) (e.g., missed opportunities, impact, or burden of death on others). For palliative care patients, fear of “running out of time” was the most prevalent among the 15 different death and dying-related anxieties measured by Vehling et al. [68]. There is a negative correlation between death anxiety and social connectedness, but a positive correlation between death anxiety and demoralization, characterized by feelings of hopelessness, loss of meaning, a sense of failure, and meaninglessness [70].

In palliative care, grief comes in many forms. “Grief and palliative care are interrelated and perhaps mutually inclusive,” writes Moon [71]. Grief and palliative care are both concerned with the phenomena of loss, suffering, and a desire to alleviate the burden of pain.” (p. 19). As an example, the COVID-19 lockdown procedures, which prevent families from seeing loved ones in palliative care, have led to a rise in anticipatory, disenfranchised, and complicated grief among patients, families, and healthcare providers[ 72]. Families who are caring for children in Pediatric Palliative Care (PPC) go through three stages of grief: anticipatory, post-mortem, and post-death. Patients may experience numbness, shock, fear, anger, and survivor guilt as a result of their spouse’s death before or during palliative care [74].

Patients in palliative care may feel isolated or lonely due to a variety of reasons, including the death of their spouse, loss of autonomy, deterioration of motor or cognitive abilities, or the recent COVID-19 pandemic [75,76,77]. More illness symptoms (such as pain, difficulty breathing, or severe exhaustion) and the use of life support in the final two years of life were found in elderly people who were lonely [78]. Sundström and colleagues [79] found that patients’ existential loneliness in home and residential care was centered on the past and present, whereas patients’ existential loneliness in hospital and palliative care was centered on the patient’s impending death. All four settings, on the other hand, reported exceptionally high levels of existential loneliness. Loneliness can lead to mental health issues, which is why some researchers believe that community-hospice settings should be implemented now.

For palliative care patients nearing death, DR-ED (dignity-related existential distress) is common. Bovero and colleagues [81] found that self-discontinuity and loss of personal autonomy accounted for 58% of the DR-ED variance in their study. Physical and cognitive decline may cause patients to stop participating in meaningful activities, resulting in self-discontinuity. Taking on new responsibilities as a grandparent or elder in the community may also be a factor. Physical and cognitive deterioration may also be a factor in the patient’s loss of independence and personal autonomy, as elderly couples often compensate for one another [82].

Damien Sendler: Every now and then, whether as a result of past mistakes or squandered opportunities, we all feel a pang of regret. Having regrets at the end of life, on the other hand, can exacerbate suffering at the end of life due to the knowledge that one cannot undo the damage done in the past [35]. Her best-selling book [36] mentioned five common palliative care patient regrets, including the wish that they had lived a more authentic life, the desire to express their feelings, and the desire to keep in touch with their friends and loved ones as they neared the end of their lives. This “unlived life,” which may play a role in the generation of death-related anxieties, is a common source of these regrets [23].

For palliative patients, meaning-centered therapies proved to be effective in improving spiritual wellbeing, senses of dignity, and meaning as well as reducing depressive symptoms and the desire for. “Dignity” is defined as “the quality or state of being worthy; honored; or esteemed” [27]. Dignity Therapy [86] focuses primarily on the significance of the patient’s life and the legacy he or she wishes to leave behind.

Meaning-Centered Psychotherapy (MCP) is another scientifically validated meaning-centered therapy for advanced cancer [87]. In the face of existential crisis, it aims to maintain and enhance a sense of meaning. Meaning-Centered Psychotherapy [88] is based on Frankl’s logotherapy and consists of 7–8 sessions in which patients reflect on the concept of meaning and the impact cancer has had on their life and identity.

Patients in Breitbart’s meaning-centered group therapy for cancer patients [89] learn about the philosophical underpinnings of meaning, engage in group exercises and homework, and engage in open-ended discussions.

Denial, anger, bargaining, depression, and acceptance are all stages of the Kubler-Ross [58] stage model of coping with death. The Death Attitudes Profile (DAP) [90] and the Death Attitudes Profile Revised (DAP-R) [91] are the results of a comprehensive study Wong and his colleagues conducted about 30 years later. Both scales have been used extensively around the world..

Three distinct types of death acceptance were identified by Wong and associates: (1) neutral death acceptance—accepting death rationally as a part of life; (2) approach acceptance—accepting death as the gateway to a better afterlife; and (3) escape acceptance—choosing death as an alternative to a painful existence.

Belief in a desirable afterlife is the root of approach acceptance. For those who hold such beliefs, the afterlife is more than a metaphor for immortality, providing encouragement and consolation to those facing death as well as those who have lost a loved one. Accepting death as a way out of the agony and meaninglessness of life is a primary factor in a person’s willingness to die. The idea behind neutral acceptance is to rationally come to terms with the fact that one’s time on this planet is finite and to make the most of it while one can.

Damian Jacob Sendler

It’s possible to accept the fact that we’ll all die, but the belief in an afterlife provides a source of comfort and hope in the face of it. Because of this, many people believe in an afterlife or heaven [92].

According to Wong’s model of two systems, death anxiety and acceptance can exist simultaneously. More than one factor contributes to a person’s death anxiety: death itself, the pain and loneliness it brings, not completing one’s life’s work, annihilation anxiety (fear of nonexistence), and concern for one’s loved ones after death. Death acceptance can be achieved through three stages: (1) avoiding death, (2) confronting or facing death, and (3) accepting or embracing death, even if death anxiety is present all the time.

One can no longer fear death if they have found a cause they believe in and are willing to die for. We can overcome our fear of death by making meaning out of our lives and pursuing a goal that is greater than ourselves. I (the first author) have also experienced the same existential struggles of trying to make sense of cancer [93] and the loneliness that comes with being in the hospital [94].

When it comes to understanding and facilitating death acceptance, Wong has used the meaning management theory (MMT). The dual-system model and existential positive psychology are the foundations of MMT. Instead of avoiding our fear of dying, MMT advises that we confront it head-on while also dedicating ourselves to an important goal [22,96].

MMT is a lot more than a reframe or a rationalization of one’s thoughts. It takes a fundamental shift from the mindset of pleasure seeking to the mindset of meaning [97] and from self-centeredness to self-transcendence [45]. In the darkest moments of life, meaning therapy [39,98] gives people the tools they need to extract meaning and hope from their circumstances.

Connections and love for one another show that each of us is part of a larger whole, a source of meaning in our lives [105]. People die of loneliness and a lack of purpose when love is withheld from them. Love is the most powerful force on the planet, don’t we know it yet? The ability to endure anything, face any danger, and enjoy making sacrifices for others are all a result of love.

It is just as vital to our mental health as it is to our physical health to have faith, hope, and love. The golden triangle represents this positive triad, which has been essential to human survival since the dawn of time. It is also critical in the fight against depression, addiction, and other forms of suffering, as well as in building a brighter future. Even in palliative care patients, the golden triangle can be used to conceptualize well-being.

Courage, Acceptance, and Transformation form the “Iron Triangle.” Even in old age, with all the inevitable losses, life can be difficult. At the end of life, one must have a great deal of courage to face the many difficulties that come with dying and passing away [106]. To deal with the agony of illness and death, to come to terms with one’s own mortality, and to make the final transition, one needs courage. One must also have the courage to connect with their own inner resources as well as their family and community in order to enhance their dignity and well-being. If we are awakened to our spiritual nature and cultivate our psychological resources, [107] our genes and brains can handle any adverse situation, as long as we are aware of our spiritual nature and cultivate our psychological resources.

Fearlessness in the face of uncertainty is a sign of existential courage ([108], p. 4). According to our previous discussion, we need existential courage at all stages of our lives: The ability to face and overcome all of life’s setbacks and obstacles is only possible when we have the guts to face our darkest selves and confront what we cannot change or control. Yang et al. [109] provides the most comprehensive treatment of courage. To them, “courage is like the existential thoughts of the will to power” in terms of spirituality. This can be found on page 13. For them, “The will to power is a process of creative energy or psychological force that is aimed at putting one’s will into action in order to overcome life’s difficulties.” (p. 12). It is also similar to Frankl’s [44] defiant power of the human spirit, which is courage.

For those who have overcome hardship and adversity before, courage is an attitude of affirmation that says “Yes” no matter what comes their way [110]. Courage is the strength and optimism we have hidden within us that allows us to push forward in the face of danger, obstacle, or suffering.

Authenticity, horizontal self-transcendence, and faith in God or a higher power are all examples of existential courage, which is a combination of these three characteristics (vertical self-transcendence). The golden triangle protects three crucial connections because it encompasses such existential courage. In the end, courage is a matter of the heart and the will.. Having the true grit to face whatever life throws at you is made possible by having an attitude of affirmation and optimism.

Professional healthcare providers who want to provide excellent end-of-life care must first accept their own mortality and have resolved their own existential conflicts about the meaning and core beliefs of their own lives. It’s easier for them to build meaningful relationships with their patients when they’re more in tune with their own sense of calling, personal values, beliefs, and attitudes.

Palliative care is founded on spirituality. The ultimate meaning and purpose of religion and spirituality are typically addressed, and certain spiritual practices or religious beliefs and rituals are often included. This sense of sacredness can be found in some transcendental beliefs (27). The spiritual maturity of the caregiver has a direct bearing on the quality of palliative care they provide. Caregivers’ commitment to self-care and spiritual growth is critical in this context. They must recognize the importance of first connecting with the source of their own well-being, peace, and harmony, which has its own spiritual component.

Considering that we’re all going to die at some point, we might as well make this final journey the most memorable and meaningful of our lives. If we want to succeed, we must begin planning now. If you want to live and die well, this may be your best option.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler, M.D. – The World Health Organization (WHO) declared a COVID-19 pandemic in March 2020. This year, there have been over 127 million confirmed cases of SARS-CoV-2 worldwide, with over 2.5 million deaths as of March 31st, 2020. 2 More than 11 million people around the world are in prison at any given time. Overcrowding, poor ventilation, and often unsanitary conditions, combined with subpar healthcare, make this population particularly vulnerable to COVID-19. There are multiple points of entry for COVID-19 because of frequent staff turnover and the movement of inmates in and out of and between prisons. There are four to five

Damian Jacob Sendler: Chronic diseases, such as diabetes and hypertension, pose a significant risk to imprisoned individuals. As a result, people from black and minority ethnic groups are more likely to be diagnosed with cancer, which has a negative impact on their health. 5 6 Therefore, it is clear that imprisoned people are at a high risk of developing severe COVID-19, which is likely to result in significant stress and anxiety for this population. To make matters worse, prisons’ infection prevention and control procedures prioritize limiting inmate-to-inmate and visitor-to-outsider contact. 13–16 All visits have been cancelled, and the amount of time that prisoners are allowed to spend outside their cells has been restricted. As a result, prisoners are spending up to 23 hours a day in their cells. This isolation could be compared to solitary confinement,15 which has been shown to have a negative effect on a person’s mental health. 17 18 It’s also worth noting that imprisoned people have a high rate of mental health and substance abuse issues. 7 There is also a high prevalence of mental health conditions among prison staff.

Dr. Sendler: For both prison staff and inmates, we conducted a literature review focusing on the effects of COVID-19 on mental health. The review’s goal was to find out how the COVID-19 pandemic affects inmates’ and prison staff’s mental health in a comprehensive way. Our research also included summarizing and analyzing the findings and pointing out where there were still holes in the evidence.

Infection control measures have severely restricted the movement of many prisoners. A practice that has negative connotations in prison because it is perceived as being similar to punitive solitary confinement is the isolation of those with symptoms and positive test results who are new to the prison or who are vulnerable to severe infection. 35–43, 47–70, 73–78 Many were concerned that isolation could lead to an increase in mental health conditions, such as anger, depression, psychosis, self-harm, and suicide, as well as an increase in self-harm.

The distinction between isolation and solitary confinement is critical in this context.

Seclusion is defined as being held for more than 22 hours a day without “meaningful human contact” in solitary confinement. 86 Penal institutions use it to punish inmates for misbehavior, but it can also be used to keep them safe from harm. In most prisons, keeping inmates in isolation separate from the rest of the population is done to prevent the spread of disease. Mental health resources such as television, tablet computers, and radios, along with reading materials and ways to contact family members should be available to all prisoners. They should also have access to health care providers and be kept informed about the length of time they will need to be isolated. 73 13 Inmates may be reluctant to report symptoms unless the purpose of their isolation is clearly defined. Ninety-three

Regardless of the COVID-19 classification, many prisons have severely restricted inmate movement.

Combined with social distancing measures, this can mean spending up to 23 hours a day in an 8 x 6 foot cell. 63 74 75 59 In contrast, Penal Reform International recommends avoiding blanket isolation measures or imposing them ‘only for the time required to conduct a more individualised and independent medical assessment’ if necessary. 58

There have been a number of activities that have been and not replaced with recommended socially distant activities.

This could have a negative impact on one’s mental well-being. 74 81 Since the number of staff members on site is restricted to minimize the risk of infection, there are fewer activities available at facilities such as gyms. 63 While in-cell activities like exercise, mindfulness and puzzles can be used to keep patients occupied, they’re not the only options. 975 88.

This means that trials and court hearings will be postponed and that incarcerated people will be held in remand for longer periods of time, resulting in additional stress.

In total, there are 1012 instances of this. For both the prisoner’s own well-being and that of his loved ones, a lack of communication can lead to increased anxiety. 69 Infants and children should be given special consideration when deciding on visits, according to the European Centre for Disease Prevention and Control. 14 Although in-person visits had been suspended in the US by early April 2020, some women in UK prisons hadn’t seen their children in two months by May 2020. 59

Due to the fact that visits are used as a means of smuggling drugs into prisons, cutting down on visits has the added benefit of decreasing drug availability and use.

Damian Sendler

Opioid substitutes are in high demand, perhaps because they can alleviate withdrawal symptoms. Item Numbers: 36-57 Prison staff and healthcare workers may have been put under additional stress due to an increase in the number of inmates who are absconding.

It’s critical to keep in touch with loved ones and friends. This has been accomplished in part by increasing telephone access. Letters, video calls, and a prison voicemail service are among the other options. However, these methods are not implemented or effective in all prisons due to a variety of policies and resources at each facility. 62, 76, 77, and So, only half of the prisons in England and Wales have access to secure phone handsets. 75 As a result, those who are most likely to harm themselves or take their own lives are the least likely to benefit from support networks. To put it another way:

Staff and inmates alike need to be able to communicate effectively. Imprisoned people have low levels of health and education literacy, which, when combined with the strict control of information within prisons, can lead to the spread of misunderstandings and misinformation. 80 Communication with inmates about protocol changes must be regular and clear. A total of 31 43 69 85 The Royal College of General Practitioners’ guidelines for managing COVID-19 in prisons place an emphasis on effective communication.

Regular services have been reduced or eliminated in many places due to infection risk despite widespread belief that the mental health burden will increase.

The following numbers represent the total number of participants: 54 Psychiatric and psychological care is widely believed to be essential, which is why this finding is shocking. Ten twelve thirty-three sixty-two seventy-two Inmates will have access to online counseling tools and telepsychiatry as part of the new adaptations. To put it another way: A number of states in the United States were urged to waive licensing requirements in order to increase the use of telepsychiatry.

Mental health services have been rationalized, and articles have called for better triaging to ensure imprisoned people with the highest risk of harming themselves or others, aggression, and a refusal to eat are prioritized.

As many as ninety-seven Risk assessment and personal protective equipment are critical for the few in-person mental health appointments that do occur. 71 41 Several articles detailed the changes and improvements made to existing systems and processes in order to allow people incarcerated to continue their drug treatment. When it came to treating opioid agonists, depot buprenorphine was the first line of defense in one prison (OAT).

Damian Jacob Sendler

To begin with, they’ll be in an unfamiliar place with a lot of cultural shifts, which can cause a lot of stress. 65 68 Imprisoned people often lack financial and social capital, have lower educational attainment, and are more likely to become homeless, all of which are more difficult to overcome with current restrictions. 68 98 99 105 0 With limited options for new housing arrangements and difficulties in obtaining a police protective order if necessary, those who return to difficult family situations are at risk for domestic violence. 68 & 89 As a second issue, many of the community services on which recently released prisoners had relied have been cut, altered or discontinued. OAT is a critical area that requires careful planning. OAT services are now available via telemedicine in some areas, but inmates must be provided with technology and an internet connection in order to use this service after they are released from prison. One hundred and sixty-one

Liaising with community services for follow-up is difficult when dealing with these additional complexities and the rapid rate of decarceration.

Damian Jacob Markiewicz Sendler: Those who work in prisons have suffered psychologically as a result of the epidemic. The number of prison staff absences in England and Wales has doubled. 75 employees are suffering from stress and exhaustion as a result of working with fewer people. A total of nine 62 80 Inmates’ mental health will suffer as a result of a shrinking labor force. 9 75 Having fewer staff members means fewer opportunities to support inmates and less time to monitor those at high risk of self-harm or suicide.

More than anything, fear of COVID-19 has had a negative impact on inmates’ mental health, which is exacerbated by the regime changes that have been implemented to reduce infection risks. The main issues are social exclusion and isolation, the cessation of prison visits, and the reduction or discontinuation of mental health services, to name a few. Inmates’ mental health risks can be effectively assessed via telephone and video calls, telepsychiatry, and socially distant in-person mental health appointments, which can all help alleviate some of these consequences. Other options include providing individual and communal socially distant activities, communicating clearly with prisoners, and decarceration.

There are indications that the pandemic has had a significant impact on the mental health of those who reside or work in prisons. Isolation poses a significant threat to inmates’ mental health while they are incarcerated. It’s well known that solitary confinement has negative psychological effects, and research shows that even five years after being released, the risk of death is increased. 108 Even if the causes of isolation differ, the effects on one’s mental health are almost certainly the same. Visitors, on the other hand, have been shown to have a positive effect on the well-being of inmates and reduce recidivism rates. 109 Mental health may also be affected by preventing visits. There is a wide-ranging and possibly long-lasting impact on mental health from quarantine, according to a quick review of the psychological impact on the wider community. 110 Longer quarantines have a more severe effect, and restricting one’s freedom is more stressful and can have longer-term effects on one’s mental health. 110

Mental health may be harmed as a result of a lack of access to health care. Since the pandemic began, health care services in many countries have grown rapidly thanks to the widespread use of telemedicine. 111 In prisons, however, concerns have been raised about the lack of equity and access to technology. Fifty of the 117 prisons in the United Kingdom had poor internet connectivity at the start of the pandemic, even in high-income countries like the United States. 112 It is imperative to address mental health issues as the pandemic continues to grow in recognition. Riots in prisons in Brazil, Colombia, Italy, and the United States have been linked to the mental health issues, and they show that solutions must be found right away.

COVID-19’s discussion of mental health in prisons lacks solid evidence. Understanding the impact of COVID-19 and the implemented regime changes is an urgent necessity in light of the vulnerabilities of prisoners’ physical and mental health. When mass decarceration occurs, prisons become places of transition, and the unaddressed mental health impact will have repercussions throughout society. As the pandemic spreads, the prison system in England and Wales is currently evaluating feedback from inmates and staff in order to better manage safety and mental health.

There are a lot of great things about this review. A scoping review of mental health in prisons during the pandemic is the first of its kind. In addition, by following a methodical approach, the relevant literature and evidence gaps were comprehensively identified, with clear implications for future research and policy. In spite of this, the findings are not conclusive because of the poor quality of articles included.

In order to gain a better understanding of the mental health impact of prisons, as well as to identify effective interventions, more research is needed. We must also look into the effects of decarceration. Newly released prisoners face a particularly high mortality rate due to drug overdoses. 114 Because drug-related sentences are one of the most frequently commuted,68 104 it is critical to examine how best to maintain continuity of care upon release. It’s noteworthy that little research has been done on female prison staff or inmates, and this needs to be addressed as well.

Damien Sendler: Inmates and employees in prisons should have their mental health taken into account. In-cell activities and the expansion of electronic communications are needed to allow inmates to communicate with health care providers and family members, as well as to allow courts to operate remotely in order to prevent a backlog of trials in prison. Inmates and prison staff must be informed of the public health measures in place so they can anticipate what to expect. In order to protect prisoners’ human rights, these measures must be kept to a minimum while still allowing for infection control. Vulnerable people are identified and monitored, services are maintained and health needs are addressed by healthcare workers. There are issues with releasing a large number of people into the community, and these people require adequate protection, such as appropriate housing and connections to health care services.. We need strong leadership and collaboration across prison systems, non-governmental organizations, and healthcare and social care partners to implement all of these initiatives.

As a result of infection control measures as well as fear of COVID-19, the impact of COVID-19 on inmates’ mental health and prison staff’s mental health is likely to be significant. Despite their importance, these must be minimized and strategies to maintain mental health implemented in conjunction with them. For example, the WHO warned in March 2020 that ‘people in prisons and other places of detention are not only at greater risk of contracting the virus COVID-19, but they are also at greater risk of human rights violations’. Action and research are urgently needed to address the negative mental health consequences of the pandemic on those who live and work in correctional facilities given the evidence so far and because this pandemic is far from over.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Autoimmune diseases are becoming more common worldwide. As a result, ocular complications associated with autoimmune diseases, from minor symptoms to potentially life-threatening scenarios, have also increased. These ocular manifestations may be caused by the disease itself or the treatments used to treat the primary autoimmune disease. ‘ Several autoimmune disorders are linked to an increase in the incidence of ocular complication.

Damian Jacob Sendler: There are two types of autoimmune diseases, organ-specific and systemic, which are both caused by the body’s immune system attacking its own self-antigens. Over 80 autoimmune diseases have been identified, but the exact cause of many of these illnesses remains a mystery. The cellular immune system plays an important role in determining disease susceptibility, prevalence, and severity.

Dr. Sendler: Some of the many eye symptoms associated with autoimmune diseases are frequently overlooked and undervalued. Minor annoyances to potentially life-threatening situations necessitate medical attention right away. Systemic changes in the body can affect the eye’s microenvironment, which can be a first sign of an underlying autoimmune disease (2, 3). When the disease is active or years after diagnosis, ocular manifestations can appear. Patients’ quality of life and even their vision may be jeopardized if treatment for these symptoms is postponed.

Every part of the eye is at risk for autoimmune-related problems. Routine ophthalmic examinations are necessary to diagnose, investigate, and treat any ocular symptoms that may arise during the course of treatment. Acute, sight-threatening ocular complications have been observed with several of the autoimmune diseases discussed in this review, making regular screening important even for those who are asymptomatic.

Between 1965 and 1995, the prevalence of autoimmune diseases was estimated to be 3.2 percent, rising to 19.1 – 43.1 percent in 2018. (4, 5). Autoimmune disease diagnosis market size is expected to grow from $4.1 billion in 2015 to $6.3 billion by 2026. (6). Genetic predisposition in an aging population, as well as improved diagnostic techniques, may be to blame for this rise. Environmental factors have played a larger role in the rise of these issues, suggesting that they can be reduced.

It is not uncommon for a single patient to have multiple autoimmunity syndromes, such as rheumatoid arthritis, thyroiditis and type 1 diabetes (7). Systemic manifestations, including those affecting the eye, can occur as a result of these conditions.

We can only speculate that the prevalence of ocular manifestations of autoimmune diseases will increase as the global population ages and the prevalence of autoimmune diseases increases. An epidemiological and recent literature review of the prevalence of ocular manifestations of various autoimmune disorders is highly desired (8–11), despite the existence of numerous reviews. Ocular complications associated with autoimmune diseases and those at greatest risk will be highlighted in this review so that proper screening and diagnosis can be taken.

Rhumatic diseases (ARDs) are an umbrella term for many conditions that affect joints, bones and muscles, with rheumatology the most common.

Chronic rheumatoid arthritis causes systemic polyarthritis, usually bilateral, with synovial tissue inflammation. According to recent estimates, 1% to 2% of the global population suffers from the disease (12, 13).

Approximately 10% to 35% of rheumatoid arthritis patients have keratoconjunctivitis sicca, or dry eye disease. Episcleritis, scleritis, peripheral ulcerative keratitis (PUK), and retinal vasculitis are other common symptoms. Keratoconjunctivitis sicca (KCS) is the most common ocular condition in rheumatoid arthritis patients, accounting for 85% of all ocular conditions in this study (14). The lacrimal gland is damaged by attacks on B and T lymphocytes, which cause dry eye disease. However, lubricating eye drops can be used to help alleviate and manage the symptoms that sufferers of itchiness, redness, and the sensation of a foreign object in their eyes. Tarsorrhaphy or occlusion of lacrimal drainage puncta may be necessary in more severe cases. In rheumatoid arthritis patients, there is no correlation between disease severity and the severity of the dry eye disease. Longer disease duration was linked to more severe dry eye (15). Relative to healthy control subjects, corneal thickness in patients with rheumatoid arthritis decreased as corneal curvature increased (16).

In up to 10% of patients with rheumatoid arthritis, the suprachoroidal layer is inflamed, resulting in episcleritis. There are topical eye drops that can be used to restrict blood vessels, but because they do not target vessels deep in the sclera, they are ineffective for treating eye diseases. However, there was no correlation between the severity of the disease and the thickness of the choroid layer, indicating the risk of potentially severe ocular manifestations in well-managed patients with rheumatoid arthritis (17).

Patients with rheumatoid arthritis (12) are more likely to develop scleritis, which accounts for 10% of ocular complications. In rheumatoid arthritis, PUK is a rare complication that is mostly reported in case studies. In one case, the rapid progression from generalized symptoms to severe bilateral PUK involving vision loss was documented (18). Without treatment, retinal vasculitis, which can cause vision loss, can develop from scleritis and PUK (19). Retinal vasculitis can be asymptomatic in some cases, reinforcing the importance of regular screening for all patients.

Lacrimal and salivary gland inflammation is a prominent feature of Sjogren’s syndrome. Due to the inflammation of the lacrimal and salivary exocrine glands, patients with Sjogren’s syndrome will experience sicca symptoms. One percent of the world’s people may be infected with HIV/AIDS, according to recent estimates (20).

One in three Sjogren’s syndrome patients exhibits ocular manifestations, and 13 percent of these are so severe that they threaten the patient’s vision (21). Dry eye disease is the most common ocular manifestation of rheumatoid arthritis and other autoimmune diseases. In the United States, one out of every ten people over 50 who are diagnosed with dry eye disease has Sjogren’s syndrome as a precursor (22). Sjogren’s syndrome diagnosis can take up to ten years for those who are diagnosed, indicating a lack of awareness of the importance of ocular manifestations in Sjogren’s syndrome.

Ocular manifestations of primary Sjogren’s syndrome include episcleritis, scleritis, retinal vaculitis, and corneal melt or perforation. Some research suggests that males are more likely to develop these ocular manifestations (23), although this finding can be challenged by other studies (24).

Chronic vasculitis of various organs, such as the eyes and nervous system, characterizes Bechet’s Disease. 70 percent of patients with Bechet’s disease have been found to have some form of ocular disorder, making it a common occurrence (25). Bechet’s disease is characterized by a gradual onset of ocular symptoms, but their importance cannot be overstated.

About two-thirds of patients with Bechet’s disease have recurrent bilateral uveitis (26), and 25 percent of them are at risk of going blind as a result (27). Bechet’s disease-associated uveitis can have serious side effects even in the early stages, including retinal lesions (75-80% of cases), cataracts (39.5 percent of cases), and secondary glaucoma (17.1 percent of cases). These complications can all lead to vision loss.

Corticosteroids, immunosuppressants, and a dexamethasone intravitreal implant were given to a male patient who had decreased vision and intraretinal haemorrhages, as well as macular oedema and disc oedema. It was clear that Bechet’s disease-associated uveitis had left an indelible mark on the patient’s vision even after the macular oedema had cleared (25). More than half of the patients in one study had macular oedema, according to research. Peripheral necrosis was the most common form of retinopathy (29).

In gastrointestinal autoimmune diseases, the immune system attacks the digestive tract’s organs. Literature case studies show that there is currently a lack of awareness about these diseases. For example, little is known about how IBD patients’ corneas are affected. Crohn’s disease patients with no symptoms of ocular involvement, however, were found to have decreased corneal thickness and decreased tear production in recent studies (30).

Chronic inflammation in the gastrointestinal tract can lead to scarring and ulceration as a result of Crohn’s disease. Crohn’s disease can strike anyone at any age, but it seems to strike most frequently in late adolescence. According to recent research, the prevalence of (31).

Episcleritis is the most common ocular manifestation of Crohn’s disease, followed by scleritis and uveitis, in that order (32). Crohn’s disease patients have a reported incidence of 5.6 people per 100,000 people with posterior uveitis (33). Before the diagnosis of Crohn’s disease, oral prednisolone has been shown to alleviate ocular lesions, mild vitritis, and intraretinal hemorrhages in a patient, with no reports of long-term ocular damage (34).

Most often seen in the early stages (36), ocular manifestations may also appear during active disease or remission. In Crohn’s disease, for example, orbital myositis has been reported more frequently than in ulcerative colitis, despite its rarity. Prednisolone and Adalimumab were used to quickly treat an acute onset of orbital myositis in a patient who had previously been disease free (37).

Corneal ulcers, blepharitis, cataracts, conjunctivitis, macular haemorrhage, subepithelial infiltrates, perivascular sheathing, and retinal vasculitis are less common manifestations, but they can also occur (36). It is more common in Crohn’s disease than ulcerative colitis to have dry eye disease (30, 38). It took five years before gastrointestinal symptoms made it possible to diagnose Crohn’s disease that retinal vasculitis was discovered (2).

The incidence of ocular manifestations in ulcerative colitis patients ranges from 4% to 12%, but uveitis and iritis are more frequently associated with ulcerative colitis than Crohn’s disease (32). Ocular manifestations were found in 83% of patients in one study; cataracts and conjunctivitis were the most common (38). Some studies have found a link between ulcerative colitis and an increased risk of ocular manifestations (39, 40), while another found a link between Crohn’s disease and an increased risk of ocular manifestations (41, 42). (41).

Vasculitis, central serous chorioretinopathy, peripheral corneal ulcers, corneal infiltrates, central retinal vein occlusion, and retinal detachment are all uncommon manifestations. Vitamin A deficiency can also cause keratopathy and night blindness (42). Ocular side effects such as vitritis, uveal effusion, choroidal neovascularization, cranial nerve palsy, and optic neuritis are less frequently encountered. A few cases of orbital myositis arising from ulcerative colitis have been documented (43, 44). It is worth noting that CRVO can cause permanent vision loss in some patients with ulcerative colitis (2, 45). ulcerative colitis and IgG4-ROD have been linked for the first time, resulting in orbital swelling (46).

Celiac disease is a long-term condition of the small intestine that affects 1–2 percent of the world’s population (47). Up to 15 percent of celiac patients are also at risk for developing Sjogren’s syndrome (48), which can lead to ocular complications.

Damian Sendler

Vitamin D deficiency can lead to cataract formation in 20 to 60 percent of celiac patients (47). Because of factors such as oxidative stress and dehydration caused by chronic diarrhoea in celiac patients, they are at greater risk of developing cataracts than the general population. Nyctalopia, dry eye disease, and corneal ulcers can all result from vitamin A deficiency in up to a third of patients (49).

For those with celiac disease but no symptoms, ocular manifestations, such as filamentary and keratomalacia, as well as corneal ulcers, can be a sign. Women are more likely to suffer from diplopia than men, so they should be tested for orbital myositis. Patients with celiac disease are also more likely to have abnormalities in the corneal epithelium (51). When celiac disease is linked to type 1 diabetes mellitus, retinopathy has been linked to the disease (52). Celiac disease has been linked to anterior scleritis (53), in which gastrointestinal and ocular symptoms were both alleviated when a gluten-free diet was resumed following gluten consumption.

Most cases of celiac disease go unnoticed because of a lack of awareness and a lack of symptoms, which can have devastating effects on the eye. Findings from the Dogan et al. study show that celiac patients who were diagnosed after 60 months had thinner subfoveal choroid layers, indicating the need for more efficient diagnosis and awareness to avoid eye complications (54).

Multiple sclerosis is a debilitating disease of the central nervous system that worsens over time. To put it another way, nerve fibers are demyelinated by the autoimmune reaction, resulting in a reduced or completely blocked transmission of signals along the nerves. In 70% of MS cases, ocular movement is affected, according to research (55). There are currently 2 million people worldwide with multiple sclerosis (56).

Optic neuritis is a common complication of multiple sclerosis, affecting 7 out of 10 patients (57) and is more common in women than men. Acute vision loss and ocular pain are the most common symptoms of optic neuritis, but the condition can also have more serious side effects. To avoid vision loss or chronic optic neuritis, patients with atypical optical neuritis must receive aggressive treatment to address the retinal haemorrhages, optic atrophy, and swelling of the optic nerve.

More than 60 percent of multiple sclerosis patients have been found to have abnormalities in their pupils (58). Internuclear ophthalmoplegia, caused by lesions on the medial longitudinal fasciculus, occurs in 30% of people with multiple sclerosis and limits eye movement (59). The most common form of nystagmus in MS patients is acquired pendular nystagmus (APN) (60). Despite the fact that APN can lead to severe visual impairment, this can be reversed with timely and appropriate treatment (61).

Uveitis associated with multiple sclerosis has a wide range of prevalence estimates in the literature, with the highest being 36 percent (62). A retinal detachment or cataract may result if the uveitis associated with multiple sclerosis is ignored.

Gullain-Barre syndrome, which causes demyelination and axonal degeneration, is estimated to affect 1 person in every 100,000 people (63). It is usually preceded by an infection of the digestive or respiratory tracts. Gullain-Barre syndrome is characterized by weakening of facial and limb muscles, as well as decreased nerve conduction. The disease worsens rapidly, sometimes in just a few weeks’ time.

In the absence of ophthalmoplegia, accommodation insufficiency and ptosis can indicate an underlying Gullain-Barre syndrome (64). It has also been documented that papillophlebitis is an initial disease manifestation that can lead to serious complications such as optic nerve haemorrhage, macular oedema, and cotton wool spots (65).

Ophthalmoparesis is a common ocular manifestation of Gullain-Barre syndrome, which affects up to 50% of patients (64). Dry eye disease and other eye symptoms can be caused by palsies of cranial nerves three, six, or twelve, which can cause esotropia, eye pain, ocular muscle paresis, corneal sensitivity, lagophthalmos, and ectropion, as well as decreased eyelid movement (66). Increased cerebral fluid and oedema in some Gullain-Barre patients can cause papilloedema (67).

Damian Jacob Sendler

Miller Fisher Syndrome (MFS) can be misdiagnosed as ocular myasthenia gravis (68) because of its similar clinical symptoms, such as lid abnormalities and pupillary dysfunction. External ophthalmoplegia causes diplopia, which is normally absent in Gullain-Barre patients. MFS accounts for 5 to 10 percent of all Gullain-Barre cases (69). Up to 25% of Gullain-Barre cases in Japan are caused by MFS (70). Gullain-Barre syndrome can also cause blepharoptosis, blurred vision, photophobia, vertical gaze palsy, internal ophthalmoplegia and abnormal lid function, mydriasis, anisocoria, ptosis and upper lid jerks. These include color-blindness, decreased visual acuity and pupillary abnormalities as well as supranuclear gaze palsy.

Receptor cells at nerve junctions are destroyed in myasthenia gravis, resulting in reduced signal transmission in skeletal muscles. There is an increased risk of thyroid eye disease for people with myasthenia gravis because of this vulnerability (71).

Myasthenia gravis is on the rise, with a global prevalence of 20 people per 100,000 people estimated at this time (72). Interestingly, a study found that ocular weakness was the first symptom in 82% of patients (73).

If you notice diplopia and symmetrical extraocular involvement (74, 75), you may be suffering from ocular myasthenia gravis, which is the most common symptom of myasthenia gravis (OMG). About 10% to 40% of myasthenia gravis sufferers have OMG (76). Pupil sparing ophthalmoplegia (PSOP), internuclear ophthalmoplegia (IOP), and thyroid eye disease (THD) are among the symptoms these patients will experience. All of the extraocular muscles can experience ophthalmoparesis, resulting in severely restricted movement of the eyeball. A study by Tang et al. found that 70 percent and 25 percent of the participants had diplopia and ptosis on their first evaluation, respectively. The lateral rectus muscle, which controls eye movement, was found in all 40 patients (73).

Blepharitis, lagophthalmos, and orbicularis weakness have all been linked to dry eye disease in 21% of OMG patients (77). (74). OMG is more common in myasthenia gravis, but nystagmus and pseudo-intranuclear ophthalmoplegia have been documented in rare cases (78). Adduction will be minimal in these patients.

It is the destruction of insulin-producing beta-pancreatic cells that causes type 1 diabetes mellitus because insulin signals cells to take in glucose. Type 1 diabetes mellitus is a systemic disease that has the potential to cause serious health issues. As a result, early detection is essential for avoiding damage to various organs, such as the eye. Type 1 diabetes, in contrast to type 2, is more commonly discovered in childhood.

9.5 percent of the world’s population will have type 1 diabetes by 2020, according to current estimates. When it comes to type 1 diabetes cases, only about 10 percent of these cases occurred in the United Kingdom between 1980 and 2014. (79).

Cataracts, glaucoma, diabetic retinopathy, and diplopia have all been observed in patients with type 1 diabetes, and the latter is more common in its early stages (80). In diabetics, age-related changes to the lens are more pronounced, as well as lower accommodation reflexes (81). In the absence of regular ophthalmic screening, vascular damage may go undetected during the prediabetic period, allowing eye disease to develop and progress before it is even discovered.

Early detection of DR is critical for the preservation of vision, as early intervention has been shown to reduce the risk of developing DR disease and the ability to prevent a decrease in visual acuity (83). Implementing early and routine ophthalmic screening could save millions of people’s vision, as DR develops in one-third of diabetes patients over 40 (84). Retinopathy was found in 27.4% of a T1DM cohort, with 8% of those cases being severe. According to 40-year follow-up estimates, 84.1% of patients had retinopathy, with 50.2% having a severe form, demonstrating the potential consequences of patients’ lack of knowledge, lack of screening, and untimely treatment (85). Srinivasan et al. also found that 43 percent of the studied cohort had worsening DR after follow-up (86).

Damien Sendler: The degree of capillary loss in patients with DR is strongly associated with decreased visual acuity; however, these changes may be asymptomatic at the time. As Duet and colleagues found, approximately 30 percent of patients who underwent OCT-A and OCT imaging showed vascular density reductions in the deep capillary plexus, even though they had no symptoms of DDR (87). For all patients, early screening is critical.

A higher incidence of glaucoma and cataracts among African American populations is seen in patients with type 1 diabetes mellitus (80). (88). Additionally, women are more susceptible to developing cataracts as a result of type 1 diabetes (89, 90). As many as 0.7 – 3.5 percent of children with type 1 diabetes (91), often within the first six months of diagnosis (92) have cataracts, which can result in permanent loss of sight. As a result, even those with no obvious cataract symptoms should have their eyes examined on a regular basis. There is, however, a paucity of data on ocular screening in type 1 diabetic children.

Hashimoto’s thyroiditis is the most common cause of hypothyroidism in developed countries because immune cells attack the thyroid (101). Rheumatoid arthritis and type 1 diabetes are two other autoimmune diseases with which it’s been linked (102). Hashimoto’s thyroiditis has been linked to eye problems, but large-scale studies are needed before these findings can be made generalizable.

In Hashimoto’s thyroiditis patients, thyroid-associated ophthalmopathy (TAO) has been reported in 6% of cases, but it is more common in Graves’ disease patients (70%). TAO risks include old age, illness, and smoking (103). Research into Graves’ disease has largely ignored the association between TAO and Hashimoto’s thyroiditis because TAO is more common in Graves’ disease. Several studies (104, 105) describe cases of severe TAO, in which the ocular muscles become enlarged. Despite its rarity, thyroid-associated optic neuropathy (TAO) can occur in patients who are not hypothyroid, highlighting the importance of conducting thorough screenings in order to avoid optic nerve compression and subsequent vision loss.

Patients with Hashimoto’s disease have also been observed to have abnormalities or differences in their corneas. A Hashimoto’s thyroiditis cohort had significantly reduced corneal hysteresis and a higher corneal compensated IOP compared to the control group, according to Kirgiz and colleagues. Reduced corneal hysteresis leads to increased pressure on the optic nerve, which can lead to glaucoma and other vision-threatening conditions (106).

Damian Jacob Markiewicz Sendler: Case studies have also shown that Hashimoto’s patients can suffer from long-term diplopia and vision loss (107). Over the course of a year, a patient previously misdiagnosed with double elevator palsy developed severe diplopia. Hashimoto’s thyroiditis was not discovered until a positive forced duction test, blood tests, and ultrasounds revealed hypothyroidism. Prednisolone was ineffective in resolving the patient’s diplopia. Patients with both typical and atypical TAO symptoms should be screened on a regular basis, according to this study. If more timely and thorough screening had been implemented, would this have prevented misdiagnosis and led to better treatment outcomes? inevitably arises.

Proptosis and hypothyroidism are risk factors for dry eye disease in up to 85% of TAO patients (108,109), but there are few studies on the disease’s manifestation. However, euthyroid patients’ dry eye disease has no relation to the severity of Hashimoto’s thyroiditis, which is milder (109). Compared to healthy controls, Hashimoto’s patients have significantly lower mean tear production and tear stability, making dry eye disease more common. Additionally, lid retraction, soft tissue swelling, proptosis and extraocular involvement have been reported (110). Dry eye disease, decreased tear production and stability, Meibomian gland dysfunction, proptosis, and decreased goblet cell density were found in this study.. Average meibomian gland area loss was 25%, but one patient experienced a 50% loss.

Scleroderma, a form of systemic sclerosis that affects multiple organs, affects up to 2.5 million people worldwide (124). Scleroderma can affect the skin or it can affect multiple organs. Swelling and joint pain are common symptoms of systemic sclerosis, which is marked by an increase in collagen production. Sjogren’s syndrome and rheumatoid arthritis have been linked to scleroderma, as have other autoimmune diseases (125). Only 20,000 people in the UK have systemic sclerosis, and that number is expected to rise by 26% in the next decade, according to the National Institutes of Health (NIH) (126).

In systemic sclerosis, there are numerous ocular manifestations of varying severity, such as abnormalities in the retina and cataracts, blepharitis, telangiectasia, scleral pits, and keratoconus (127, 128). Following dry eye disease (64.71 percent), skin alterations of the eyes (56.86 percent) and retinal abnormalities (56.86 percent) were the most common findings in one study (50.98 percent ). Patients may experience choroidal atrophy as a result of a lack of blood supply (129). Grennan et al. conducted a small-scale study and found that choroidal abnormalities were present in 50% of the patients, even though dry eye disease and retinal abnormalities were not common in these patients (130). There was corneal steeping, severe dry eye disease, and decreased tear stability in one keratoconus patient (131). When scleroderma interferes with iris pigments, transillumination occurs (132). Patients with scleroderma have been found to have subfoveal choroid layers that are less dense.

Nearly all patients with systemic sclerosis have dry eye disease (133). Despite the fact that only a third of their study participants reported dry eye symptoms, almost half reported decreased tear secretion, which suggests that dry eye disease may be on the horizon (134). Dry eye disease can be caused by lacrimal gland fibrosis, chronic blepharitis, and meibomian gland dysfunction. Patients with scleroderma have reported experiencing eyelid stiffness in up to 65 percent of the patients studied (125). It can lead to a condition known as lagophthalmos, which puts patients at risk of infection or damage (132).

The limited disease type has ocular manifestations as well. Ptosis, uveitis, dry eye, episcleritis, orbital myositis (135), and decreased size of the globe and ocular muscles are just a few of the many ocular symptoms of En Coup de Sabre (ECS) (136). 26 percent of ECS patients reported experiencing ocular symptoms. Diagnosis of keratopathy, retinal detachment, restricted eye movement, diplopia, cataracts, and corneal astigmatism (136). Adie pupil has been reported as an early disease indicator of ECS, despite its rarity (135). Ocular symptoms are more common in the ESC subtype in children (137), but linear scleroderma is more common in children (138). As well as retinal detachment and uveitis associated with linear ECS scleroderma, it has been linked to retinal telangiectasia (138).

All of the autoimmune diseases examined in this review have ocular complications, ranging from minor symptoms to sight-threatening scenarios, despite the fact that they are frequently underestimated and ignored. Misdiagnosis, delayed treatment, and a lack of awareness about the disease can all have long-term consequences on a patient’s vision. Epidemiology studies and market reports show that autoimmune diseases are becoming more common around the world. Environmental factors, such as the increasing westernization of lifestyles in Eastern countries, are expected to contribute to the current increase in population. Many autoimmune diseases are predisposed to be more severe in women due to gender-specific genetic factors. Even in patients who are asymptomatic or only show subtle ocular symptoms, clinicians can better diagnose, screen for, and treat autoimmune diseases and their associated ocular manifestations by identifying those most at risk. In many cases, the eye can serve as a warning sign of an underlying illness. As a result, doctors should make use of this useful tool and not ignore any minor ocular symptoms that occur in the absence of more obvious signs of disease.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: An epidemiological transition, from communicable to non-communicable disease, and a geological transition that is moving the planet beyond the Holocene epoch in which human societies have thrived, have been linked to industrialization and urbanization, respectively. High-income countries’ lifestyles play a major role in both processes. It is our goal to bring attention to the links between chronic disease and environmental change in order to promote a more holistic approach to environmental and public health issues. 

Damian Jacob Sendler: Biophysical environments can be incorporated into SDH frameworks but are treated as determinants that are distinct from the social factors that influence them. It is more common for environmental frameworks to portray the environment and its ecosystems as the result of human activity. The combination of public health and environmental sustainability can be achieved through some frameworks that also consider human health as an outcome. Public health officials’ concern for individual risk behaviors is broadened by environmental analyses of household impacts, which point to the more harmful lifestyles of high-income households. 

Dr. Sendler: Rapid environmental change is threatening the foundations of health. Frameworks that span public health and environmental sustainability are needed, as is a common evidence base that captures the harmful effects of high consumption on both health and the environment. 

Increasing living standards and longer lifespans have been made possible by the simultaneous processes of industrialization and urbanization over the past century or so. 

Numbers 1 and 2 Rapid alterations in people’s habits, such as increased physical activity and a shift in diet, have been linked to these improvements. This has resulted in a shift from a plant-based diet to one based on animal products, such as dairy products, meat, and processed meats, in the workplace and on the road. Three, four, five and six 

As a result of these societal and economic shifts, a shift in epidemiology has taken place as well. Non-communicable disease has overtaken communicable disease as the leading cause of ill health and premature death in high-income countries and around the world since the early industrialization of North America and Europe. Then there’s nine. Physical inactivity and poor diet are the most direct determinants of heart disease risk. 3, 7, 9, 

Land surface, oceans, atmosphere, and cryosphere have all changed as a result of industrialization and urbanization. Ecosystems are at the core of these systems, and they consist of the interdependent communities of plants, animals, and microorganisms as well as their non-living surroundings. 10 Ecosystems provide the resources that sustain human life on a variety of spatial scales (e.g. a field within a farm within a rural community within a region). Soil formation, climate regulation, and oxygen production are just a few of the many essential services provided by ecosystems. 12, 11 There is a direct link between environmental and climate change and ecosystem decline, which in turn has a direct impact on human health and well-being Instances 11 through 13 

Damian Sendler 

Changes in the Earth’s systems and ecosystems have been evident since the 19th century because of human activity. 

However, since 1950, the pace and magnitude of anthropogenic change have accelerated sharply, with the decade marking the beginning of ‘The Great Acceleration’ in the human transformation of the global environment. 15 As a result, many species are unable to keep up with the rapid changes in their environment, which are resulting in the loss of biodiversity and oceanic ecosystems16, 17 as well as an increase in CO2 levels in the atmosphere and the surface temperature of the ocean. 18 These environmental stress indicators are taken as proof that human-induced alterations to Earth’s climate are causing a geological shift: humanity has emerged as a global geophysical force. The Earth is entering a new “human-dominated geological epoch” after the stable environmental boundaries of the Holocene epoch, during which human societies have grown and prospered. 19 A number of Earth’s systems have gone “no analog,” posing new and unprecedented threats to human health, many of which will fall disproportionately on the world’s poorest people, who have made the least contribution to global warming and environmental degradation thus far. The ages of 17 to 22 

Consumerist lifestyles, in particular the high levels of consumption associated with affluent societies, have been implicated in environmental change and geological transition as a result of economic growth. 

23 Population growth has increased environmental pressures, but it has been primarily due to an increase in per capita consumption of Earth’s finite resources by “a small fraction of the human population,” namely those living in high-income societies. 15 As a global aspiration and, increasingly, a global norm, the consumption patterns of wealthy societies are becoming increasingly damaging to the environment as a result of “a cultural globalization”24. 25 Emerging economies and other middle-income countries are increasingly driving environmental and climate change because of “the convergence of aspirations on high consumption patterns”26. 27 

Research and policy on chronic disease and environmental change, though related, have been separated because of their common roots in modern society’s lifestyles. However, with environmental and climate change putting increasing pressure on both public and planetary health, there are increasing calls to bring health and environmental perspectives closer together. 22-22-28, 29-30-31 It’s our hope that our paper will help fulfill this urgent need. 

We are aware of the barriers that can prevent cross-disciplinary and cross-sector understandings. 

Damian Jacob Markiewicz Sendler:  Barriers to ‘thinking outside the box’ include difficulties in accepting ideas and perspectives from other fields. A number of studies have shown that concepts can be helpful in this regard. Unlike evidence, they can mediate understandings and facilitate dialogue across disciplinary and policy boundaries. 35 Science studies concepts can be used as ‘boundary objects’ to connect the research and policy communities,36,37 in the language of science studies. Both social determinants and healthy lifestyles are important concepts in public health, so we’ll concentrate on them here. They are compared and contrasted with environmental perspectives to see if there are any points of convergence. 

In the following section, we’ll talk about social determinants and the frameworks that have been used to identify the channels through which they exert their influence. Policy-facing research frequently employs frameworks, which are visual representations of complex processes, in order to facilitate cross-disciplinary and policy-related communication. 39, 38 A social determinants of health (SDH) perspective, we argue, obscures the natural environment’s position as an outcome shaped by the same factors that influence health. For example, many frameworks emphasize environmental change and ecosystem function over social determinants, and some of these frameworks include a focus on human health as an important consideration as well. A simple illustration of an integrated framework illustrates the synergies between the various frameworks. 

Modern lifestyles are another focus for bridging public health and environmental perspectives in the following section. An environmental perspective on household consumption practices is discussed in this section to enhance public health’s focus on the individual and their behavioural risk factors. Public Health readers may be unfamiliar with some of the terms used in the paper, so the authors have provided an online glossary. 

The concept of the SDH is frequently used as a basis for public health frameworks. 

the 1970s, which was a time when governments in high-income countries were concerned about the economic and health burden of chronic disease. In the wake of a series of criticisms of a narrow focus on lifestyles as the cause of chronic disease, the concept was born. 42 Critically, critics argue that such a focus diverts attention from the social causation of disease, and advocate’refocusing upstream…toward a range of upstream political and economic forces’.. 44 WHO’s Health for All agenda emphasized these upstream influences, noting that health is “influenced by a complex of environmental, social, and economic factors ultimately related to one another.” 45 

Damien Sendler: As far back as the early 1990s, Dahlgren and Whitehead provided a visual representation of this complex process. There were many interconnected factors that contributed to one’s overall well-being in their “rainbow” model of the most important health determinants. These factors ranged from broad societal factors like “general socioeconomic, cultural and environmental conditions” to more specific ones like “living conditions” and “individual lifestyle factors.” 46 The WHO’s Commission on the Social Determinants of Health47 and its subsequent reviews were based on the concept. 48 Both lifestyle risk factors and their broader determinants (the “causes” of those risk factors) are social in origin, as the reports made clear. Global and national public health policies have been shaped by SDH approaches,41, 49 with a particular emphasis on policies to improve access and quality of life. 51, 50 

SDH approaches, on the other hand, have been less successful in articulating where and how the natural environment contributes to both individual and population health.. 

49, 52, 41 According to the WHO Commission’s focus on ‘the fundamental global and national structures of social hierarchy and the socially determined conditions these create’, its conceptual model emphasizes the’socioeconomic and political context’, to people’s social position (social class, gender and ethnicity), and to their material and psychosocial circumstances. There is no mention of the environment. Lalonde’s “fields” of health, which include environmental and lifestyle factors, are also included in other models, such as this one. 53 Water and sanitation are also included in Dahlgren and Whitehead’s “rainbow” framework,46 which includes environmental conditions as part of the overarching arc of the model (referred to in the model as “general socioeconomic, cultural, and environmental conditions”). The social environment, including housing, workplaces, and social relationships, has long been the primary focus of public research and policy, rather than on the biophysical environment in which it is embedded. 30; 41; and 54 As Rapport et al.55 note, the biophysical environment is ‘the human habitat’ and is being rapidly degraded by human activity. This absence matters. 

Damian Jacob Sendler 

Health frameworks that emphasize ‘the human habitat’, however, are more prevalent. Blum’s input-to-health model56, published in 1974, was an early example of this notion that the environment is a “huge input to health.” In addition to ‘natural environment’, ‘natural resources’, and “ecological balance,” his environmental input includes ‘natural resources’. Dahlgren and Whitehead’s framework is an example of a more recent framework. 57 The model’s outer arcs are widened, as shown in Fig. 1, to give more weight to environmental factors as health-related determinants. ‘Building environment,’ ‘natural environment,’ and ‘global ecosystem,’ or ‘climate change and biodiversity,’ are the three concentric arcs that make up the environment. 

Because of their causal structure, they include the biophysical environment as a determinant, but not the social factors that have an impact on health. This is not to say that these factors do not have an impact on the biophysical environment, but rather that they play a key role in the Great Acceleration’s anthropogenic drivers. This suggests that the concept of the SDH is driving the change from the Holocene to a ‘human-dominated geological epoch. It is therefore necessary to position human health and Earth’s life-sustaining systems as outcomes of an integrated set of socially determined factors in frameworks. 

Environmental science and policy frameworks provide a base from which to build. There are general frameworks for describing human-caused environmental change and its consequences, as well as frameworks that focus more specifically on changes in the essential services provided by ecosystems. 

OECD’s Pressure-State-Response framework (PSR) is the first set of frameworks to have their roots in the OES. 

59 In this model, economic and environmental agents are linked by a causal chain that begins with “pressures from human activities” and ends with “state of the environment and natural resources.” As a tool for environmental analysis, this well-known model has been refined over time. 

As part of the European Environment Agency’s DPSIR framework, developed in the 1990s, 

60 For example, human drivers (e.g. transportation) were distinguished from environmental pressures (CO2 emissions), and the state of the environment was separated from impacts (e.g. air, soil, water quality) (e.g. on human health and biodiversity). Environmental health indicators were further refined using the model. Between’state’ and ‘impacts,’ the word ‘exposure,’ was added. In order to better understand how the physical environment affects human health, Morris et al.63 developed an updated version of the original Driver-Pressure-State-Exposure-Effect-Action model61, 62. Contextual influences include “social, economic, demographic, and behavioral factors,” according to the revised framework. 

Frameworks that focus on ecosystems and their essential role in sustaining human and planetary health also share the same basic causal structure. 

64 The MEA, a global scientific assessment launched in 2001 under the auspices of the United Nations, documented this role. ‘Indirect drivers of change,’ “direct drivers of change,” “ecosystem services,” and ‘human well-being and poverty reduction’ make up the framework’s overarching conceptual framework11. Upstream forces and causes of the causes are generally referred to as ‘indirect drivers’, which include demographic, economic, and sociopolitical factors, in SDH perspective. Changes in land use and species introduction or removal, harvest and resource consumption, and climate change are all direct drivers in the MEA framework. Both sets of drivers, as well as related changes in ecosystem functioning, have an impact on human well-being (e.g. climate regulation and the capacity to provide food and water). Even though well-being refers to “basic material for a good life,” “health,” “good social relations,” and “security,” this component of the framework refers only to “freedom of choice and action.” 

The MEA Health Synthesis report provides a detailed framework for understanding the links between human activity, environmental degradation, and human health. 

17 This Health Synthesis Framework connects more directly with the SDH perspectives familiar to public health practitioners than does the overarching MEA framework (Fig. 2). Direct, ecosystem-mediated, and indirect health outcomes have been identified. Since ‘escalating human pressure on global environment’ is at the root of both PSR models and MEA framework, it follows that social factors are the primary ones. Clearly, there is a causal connection between the models that gives precedence to social determinants of health. 65 Their impact on biophysical conditions, ecosystem functioning, and, ultimately, human health is due to these external drivers. 

Their common causal structure suggests that integrated frameworks that span public health and environmental sustainability are possible. MEA Health Synthesis framework (Fig. 2) has great potential because it is simple but covers important processes and links. Since social determinants have both direct and indirect effects on health, we use this framework to inform the schematic framework below (Fig. 3). From SDH and DPSIR frameworks and MEA approaches, the structure of this framework is intentionally based on other well-known policy frameworks. In the same way as these frameworks, it enables constituents of the framework (e.g. the interactions between social determinants and environmental change) to be represented in separate and more complex models. 

The high-income society’s way of life is crucial in determining health and environmental conditions on a social level. In the following section, we examine public health and environmental viewpoints on modern lifestyles in greater detail. 

There has always been a strong link between environmental conditions and human health. Until the mid-20th century, these conditions provided a stable foundation for society and health advancement. As a result, the free-market approach to economic and social development has taken the Earth’s resources beyond their stable boundaries, putting future generations at risk. Consumption-based lifestyles have played a key role in this process as a source of economic growth and prosperity. They have also played a significant role in the evolution of disease patterns. 

There is a growing understanding that environmental sustainability and public health are inextricably linked. Because of this, they must be viewed and addressed as a whole. By focusing on concepts that illuminate their common causes, we have contributed to the development of a shared perspective. Within the field of public health, the concepts of social determinants and healthy lifestyles are well-known and widely used; they also have an environmental counterpart. 

Public health research and policy are aided by the use of frameworks that include social determinants in their definitions. The frameworks, on the other hand, tend to obscure the effects of social determinants on broader environmental conditions. Individualistic and risk-focused approaches to disease causation are prevalent in the way lifestyles are viewed. These perspectives can be broadened through the use of environmental frameworks. They demonstrate that the ill effects of human activity on the planet’s natural systems and ecosystems can be traced back to the economic systems, built environments, and way of life of countries with affluence. Environmental perspectives that emphasize the household as a consumption unit can broaden and complement the focus on individual behavior in public health, as we found out in our research. Environmental and health impacts can lead to a variety of social gradients. We saw the potential for a combined framework in light of these synergies. Both human health and the environment are depicted as socially determined outcomes of dominant forms of economic and social development in our example. 

In order to ensure that people can be healthy, the public health community is tasked with ensuring that the conditions are in place. 

Public health and environmental sustainability must be integrated into a common agenda, with alliances and partnerships that connect across societies, disciplines, and policy areas.. This urgent global endeavor could use a little help from our paper.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Even though an increase in mental health issues is predicted, the medium- and long-term effects of COVID-19 are not yet known. To lessen the impact of COVID-19 on one’s mental health, it may be necessary to employ a variety of approaches spanning the social, economic, and psychological spectrums. It appears that psilocybin therapy is a promising transdiagnostic treatment strategy for a range of disorders with restricted and maladaptive habitual patterns of cognition and behavior, including depression, substance abuse, and obsessive compulsive disorder. Phase 2b double-blind trial of psilocybin therapy in antidepressant-free, treatment-resistant depression (TRD) is underway to evaluate the safety, efficacy, and optimal dose of psilocybin. Imperial College London Psilodep-RCT results comparing the efficacy and mechanisms of action between psilocybin therapy and the selective serotonin reuptake inhibitor (SSRI) escitalopram are soon to be published. Efficacy and safety in treating TRD patients with a combination of psilocybin and SSRIs are still unknown. Psilocybin therapy may be affected in the future by the results of an additional COMPASS study, which will be conducted in Dublin. While still in its early stages of clinical development, psilocybin therapy has the potential to play an important therapeutic role in post-COVID-19 clinical psychiatry for a variety of mental disorders, despite the enormous challenges of COVID-19.

Damian Jacob Sendler: When faced with a crisis, people experience a wide range of emotions and exhibit varying degrees of adaptability. Anxiety, depression, and feelings of isolation are all possible outcomes of the COVID-19 pandemic because of the uncertainty it creates as well as the social isolation it causes (Holmes et al. 2020, Luykx et al. 2020, Vindegaard & Benros, 2020). A rise in psychological and psychiatric problems is expected in the medium to long term (Horesh and Brown, 2020; O’Connor and colleagues, 2020; Türközer and angullar, 2020), which will place an additional burden on those who are already at risk (Horsh and Brown, 2020; O’Connor et al., 2020; Türközer and angullar, 2020). (Kelly, 2020). COVID-19’s toll on people’s mental health may be lessened through the application of a variety of multidisciplinary strategies at the social, economic, and psychological levels.

Dr. Sendler: For a variety of disorders, including depression, OCD, and addiction, psilocybin therapy has been shown to be an effective therapeutic strategy (Carhart-Harris et al. 2016, Davis et al. 2019). (Garcia-Romeu et al. 2019, Johnson et al. 2017). In addition, psilocybin therapy for anorexia nervosa is being studied in clinical trials (NCT04052568), and psilocybin therapy may have a role in the treatment of anxiety disorders (Weston et al. 2020).

Damian Sendler

The therapeutic effects of psilocybin therapy are being gradually unraveled thanks to recent advances in psychedelic science (for example Carhart-Harris & Friston, 2019, Lord et al. 2019, Preller et al. 2020, Varley et al. 2020). Because of agonist mechanisms at the 5-HT2A receptor, psilocybin consistently alters a person’s state of consciousness, especially in the deep pyramidal cells of the cortex (Nutt et al. 2020). Transient, dose-dependent alteration of the complex interconnected neural networks of the brain (Lord et al. 2019) encompassing the self-reflecting “ego,” induced by psilocybin, can lead to profound experiences of connectivity with others and the environment, and can be harnessed by psilocybin therapy to re-conceptualise restricted and masked experiences (Erritzoe et al. 2018, Griffiths et al. 2006, 2016, Grob et al. 2011).

Since it can be used in other diagnostic contexts, the precise-personalized approach provided by psilocybin therapy allows for a translatable and transdiagnostic treatment strategy (Kelly et al. 2017, Lewis et al. 2020, Preller et al. 2016, 2020, Studerus et al. 2012). Psilocybin therapy is critical because of the wide range of responses, high relapse rates, and contraindications for people with psychosis and manic-depressive illness (Carhart-Harris et al. 2018). Psilocybin therapy may be useful in the treatment of internalizing disorders, according to some researchers (Nutt & Carhart-Harris, 2020). Psilocybin’s transdiagnostic potential could also be leveraged to enhance the targeted application of psilocybin therapy and further unravel mechanisms underpinning the acute and long-term therapeutic effects (Insel, 2014), as well as a dimensional framework (Insel, 2014). Even more research into the impact of psilocybin on neuroimmunoendocrine pathways, such as the microbiome-gut-brain-axis (Galvo, 2018; Hasler, 2004; Nau, 2013, Strajhar, 2016; Szabo, 2015), may shed light on the long-lasting therapeutic effects of the drug (Kelly et al. 2019c, Kuypers, 2019).

In spite of the limitations of animal models, preclinical data have shown that serotonergic psychedelics including psilocybin can induce hippocampal neurogenesis and promote dendritic spine growth and synapse formation in the prefrontal cortex (González-Maeso and colleagues 2007; Ly et al. 201; Catlow and colleagues 2013; Morales and colleagues 2017). 5-HT2A receptor-mediated glutamate release has been shown in preclinical studies (Ly et al., 2018), and a magnetic resonance spectroscopy study in healthy humans found that taking psilocybin led to an increase in glutamate in the medial prefrontal cortex after just one dose (Mason et al. 2020).

Damian Jacob Markiewicz Sendler: Psychedelic and consciousness researchers at Johns Hopkins University have been studying the claustrum, an area of grey matter that lies between the insular cortex and the putamen, and is thought to be involved in cognitive task switching. The claustrum contains a large number of 5-HT2A receptors and glutamatergic connections to the cerebral cortex (Barrett et al. 2020b, Krimmel et al. 2019). Using 15 healthy volunteers, psilocybin reduced the activity of the claustrum, as well as its connectivity with the default mode network and the frontoparietal task control network, indicating that this region is a key mediator in psilocybin therapy (Barrett et al. 2020b).

Research conducted by the same team found that psilocybin reduced negative affect and amygdala responses to emotional stimuli one week after psilocybin, but that the responses returned to baseline one month after psilocybin use (Barrett et al. 2020a). After psilocybin, there was a global increase in brain functional connectivity one week and one month later (Barrett et al. 2020a). Psilocybin reduced amygdala reactivity to negative and neutral stimuli in healthy controls, according to a previous study (Kraehenmann et al. 2015). One study of 19 people with TRD found that psilocybin decreased functional connectivity between the ventromedial prefrontal cortex and the right amygdala one day after psilocybin treatment (Roseman et al., 2018) but increased amygdala responses to emotional faces (Mertens et al. 2020). The complexities may necessitate additional research.

Damian Jacob Sendler

To address the ‘Psychedelic Revolution in Psychiatry’ (Nutt et al., 2020) and possible increases in recreational psychedelic use (from 0.55 percent to 0.86 percent, respectively, in 2015 and 2018), the Royal Australian and New Zealand College of Psychiatrists (RANZCP), published a clinical memorandum on ‘Therapeutic use of psychedelic substances’ (Yockey et al., 2020). (RANZCP, 2020). This memorandum acknowledges the therapeutic potential of psychedelics, but also the need for more efficacy and safety data, particularly on the potential long-term effects, to inform future use in psychiatric practice.

Acceptability and tolerance were measured by the Global Drug Survey (2019), which polled 85,000 people. The results showed that only 18% of those who had not previously used psychedelics said they would accept psilocybin therapy for depression or PTSD, rising to 59% among those who had (Winstock & Johnson, 2019). There were concerns about “brain damage and bad trips,” according to the information available (Winstock & Johnson, 2019). No significant psychological problems were found in the 16-year study by John Hopkins University’s psilocybin therapy team, which involved 250 volunteers and 380 sessions. Of those, only 0.9% of volunteers experienced minor or transient psychological problems (Carbonaro et al. 2016). Many studies have examined the long-term effects of psychedelics, but there are not enough high-quality clinical studies to draw conclusions. In the case of hallucinogen-persisting perception disorder (HPPD), for example, there is a dearth of information on the condition (Halpern et al. 2018; Martinotti et al. 2018; Orsolini et al. 2017). Most of the time, a review by Halpern and colleagues suggests that HPPD is caused by over-activation of neural visual pathways that worsens anxiety following the ingestion of arousal-altering drugs, including non-hallucinogenic ones (Halpern et al. 2018). Pre-drug use complaints of tinnitus, eye floaters, and concentration problems, as well as a personal or family history of anxiety, may indicate vulnerability to HPPD, according to the authors (Halpern et al. 2018). Regular psychedelic use, on the other hand, has a limited effect on the brain (Bouso et al. 2015; Halpern et al. 2005). To be clear, in the majority of clinical trials involving psilocybin, the drug is administered in doses ranging from one to three times the usual therapeutic dose.

A double-blind, randomised, controlled phase 2b COMPASS trial of psilocybin therapy in TRD (COMP001) is taking place at the Dublin clinical trial center (Kelly et al. 2019a). The results of this large-scale study and others will address concerns about psilocybin safety, efficacy, and dose optimisation.. In addition, we eagerly await the results of the potentially paradigm-shifting double-blind trial of psilocybin therapy versus SSRI escitalopram at Imperial College London’s Centre for Psychedelic Research (Psilodep-RCT, NCT03429075) in depression (Nutt & Carhart-Harris, 2020) and acknowledge that for some people with depression, SSRIs and psilocybin may become (Carhart-Harris & Nutt, 2017). It is important to determine the safety and efficacy of antidepressants for people with depression, as many choose to continue taking them (Kelly et al. 2019b). In contrast to 5-HT2AR antagonists, such as ketanserin, 5-HT1A partial agonist buspirone may have inhibitory effects on the therapeutic effects of psilocybin (Preller et al. 2017). (Pokorny et al. 2016). However, psilocybin therapy in combination with SSRIs has never been investigated in TRD aside from anecdotal evidence suggesting a blunted effect (Bonson et al. 1996; Bonson & Murphy, 1996).

Damien Sendler: To determine the antidepressant effects of psilocybin therapy in people with TRD who are still taking SSRIs, a new COMPASS clinical study (COMP003) will be launched in Dublin and San Diego. Open-label study: 20 participants with at least a 3-month or 2-year history of clinical depression that has not responded to at least two pharmacological treatments will be recruited for this exploratory open-label study. Participants who have been taking an SSRI for at least six weeks will be given a single 25mg dose of oral psilocybin with psychological support. For future phase 3 trials in TRD, which could pave the way for psilocybin therapy to be integrated into clinical psychiatry based on these results, the findings of this study could have significant practical implications.

Clinical and research psychiatry have been transformed by COVID-19, requiring additional strategies to overcome the significant challenges (O’Brien & McNicholas, 2020; Türközer & ngür, 2020). Several measures will be implemented in accordance with local and national guidelines in order to reduce the spread of COVID-19 and facilitate the safe reopening and progress of ongoing psilocybin trials. For example, participants and researchers can use respiratory symptom checklists, temperature checks, access to COVID-19 testing, extra hygiene measures, personal protective equipment, and even remote study visits if it is not expected to have a negative impact on the participant’s experiences (where possible by the protocol). Psilocybin therapy, at the forefront of translational neuroscience and psychiatry, is likely to play an important role in post-COVID-19 clinical psychiatry, despite the challenges and early stage of clinical development.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: “Hypostatic abstraction,” which is central to the identity of contemporary medical specialties, such as psychiatric care, involves treating diseases or disorders as entities or conditions that individuals have. Psychiatry’s status as a medical speciality is challenged by mad activism, which opposes this idea. In this essay, the hypostatic abstraction is developed and used to medicine in order to better understand the difficulty of Mad activism. In order for psychiatry to remain a medical specialty while dealing with the challenges posed by Mad activism, it must establish a new understanding of the therapeutic interaction. This article poses two fundamental framing questions in an attempt to elaborate on this concept: To what end should the clinical encounter be directed? What is the overall goal of this encounter? Clinical encounters may satisfy the demands of Mad activism by including notions like as “secondary insight” (the goal of understanding) and “identity-making” (a therapeutic goal).

Damian Jacob Sendler: Psychiatry has a distinct identity that is shaped by a set of shared conceptions of what it is and what it is for. Psychiatry’s medical speciality distinguishes it from other fields of medicine. Medical physicians choose the specialization they wish to specialize in throughout their first few years of school. 1 Ophthalmology, cardiovascular, gynecological and pediatrics are among them. A number of commonalities exist across the many modern medical specialties: they all focus on the diagnosis and treatment of medical problems, illnesses, and diseases, and they all rely on basic sciences like physiology, anatomy, histology, and biochemistry as well as technology. Even as physicians are increasingly framing their work in ways that take into account the whole person, recognizing conflicting values and their implications for diagnosis and treatment, and acknowledging the role of the arts and humanities in medical education and practice, these features characterize modern medical specialties (see, e.g., McManus, 1995; Cox, Campbell, and Fulford, 2007; Cook, 2010; Fulford, van Staden, and Crisp, 2013).

Dr. Sendler: To separate itself from other medical specialities, psychiatry addresses mental health issues or disorders, as opposed to bodily illnesses or diseases. Mental illness and the consequences it has raises some difficult questions for psychiatry, which can lead some to question the specialty’s legitimacy. These questions include whether psychiatry can be considered a legitimate medical field, the explanatory limitations of its theories, and the classification errors that plague the field. In these three areas, there are continuing arguments that don’t seem to be reaching a conclusion at this time. 2 As a result of new methods to mental health advocacy, a fundamental challenge to psychiatry’s status as a medical speciality is now taking precedence over these previous discussions. 3 When it comes to mental disease and mental disorder, these methods, which I term to as Mad activism, do not believe that individuals have a problem that needs treatment. Insofar as psychiatry aspires to define itself as a branch of medicine, the concept that medicine treats illnesses, disorders, or diseases, lies at the core of medical practice and philosophy. It is via its rejection of the concept that individuals “have” a “condition” that it challenges the legitimacy of psychiatry as a medical field.

Damian Sendler

My purpose in writing this piece is to explore how psychiatry may meet the problem of Mad activism in a professional setting. In Section II, I elaborate on this issue and compare it to other mental health advocacy strategies. The “hypostatic abstraction,” a logical and semantic activity initially discovered by the philosopher Charles Sanders Peirce, is discussed in Section III of this paper. Hypostatic abstraction is at the very core of medical practice and philosophy, I argue, inasmuch as the illness is posed as something to be controlled and treated. The hypostatic abstraction is rejected by Mad activism as a threat to psychiatry. My answers to this problem are outlined in Section IV. There must be an extra notion of the clinical encounter in order to interact with both persons who believe they have a mental illness and those who don’t, so that the medical speciality may keep its medical identity while simultaneously coping with the problem of Mad activism. In order to better understand this notion, I’d want to ask two essential questions: To what end should the clinical encounter be directed? What is the overall goal of this encounter? Sections V and VI, respectively, address these concerns. When it comes to the clinical interaction, I believe that “secondary insight” and “identity-making” may be used to accommodate the challenges posed by Mad activism.

In spite of longstanding dissatisfaction about the treatment of those deemed to be mentally ill, the 1970s are seen as a turning point in a surge of activism that continues to this day.

4 Civil rights activities by black, homosexual, and women’s civil rights movements sparked other mental health groups to organize for the rights of psychiatric patients and to improve the mental health facilities they were in. While long-standing concerns about forceful treatments, lack of recovery engagement, restricted access to treatment, and societal stigma have long been a part of the c/s/x movement’s vocabulary and actions, some activists have also criticized the medicalization of lunacy. Here, I’ll refer to it as “Mad activism,” which includes features of Mad Pride and mad-positive activism.

As opposed to treatment-focused efforts, mad activism views the issue as one of respect and acknowledgement. Public representation and worth of people’s identities is at risk, with the mainstream view of lunacy as a mental condition being perceived as an attack on a positive identity. This is the issue at hand.” Reforming psychiatry is only one part of the plan; a broader objective includes influencing public perceptions of mental illness. campaigners “have moved beyond treatment-centered activism to articulate a wider culture of madness,” write Schrader, Jones, and Shattell (2013, 64). When it comes to organizing around concerns of identification and recognition, Mad activism shares goals with other social movements. For example, in the area of sexual orientation and gender, homosexual rights and trans rights are not only concerned with preventing discrimination in the workplace, but also obtaining symbolic and cultural restitution in society.

Damian Jacob Markiewicz Sendler: Many issues are raised by the claims and demands of Mad activism. Activists, for example, contend that mental illness is a valid basis for a person’s identity. Even if a positive view of mental illness is maintained, how is it possible to acknowledge the suffering and limitations that come along with these conditions? What moral and political arguments may sustain the demands of Mad activism, and what are the proper social and political responses? All of these are issues that I’m currently addressing elsewhere (Rashed, 2019b, 2019a).

The activists’ denial that they have a medical ailment that need treatment is the primary topic of this article. The question is whether or not psychiatry can accept this assertion. To what extent does this issue extend beyond the realm of activism? Psychiatrists regularly find themselves in the position of diagnosing people who don’t believe they have a medical ailment that warrants treatment. Regardless of what a patient believes, there is precedent for involuntary custody in cases when the patient has mental illness, lacks awareness of his condition, and meets the legal conditions for detention, which may include a danger to oneself or others. However, given that this is the usual course of events, I’d want to know how things may continue forward if we take the individual’s rejection of the premise that they have a condition as the starting point for any future discussions. How well prepared is the clinical (psychiatric) encounter to handle this situation? 6 Although individual clinicians may have the expertise and insight to address this predicament, I argue in what follows that psychiatry as a body of knowledge and as a set of institutional procedures does not have the conceptual resources to do so. “Hypostatic abstraction” is an important explanation for this, and it may be summarized in the concept of physicians treating things that individuals have, or “things they have,” as opposed to “things they don’t have.” As a result, psychiatry is dedicated to the notion that is rejected by the patient in the therapeutic encounter. Psychiatry’s status as a medical speciality is challenged by the focus on encounters between patients and their doctors. The hypostatic abstraction is an important concept to understand before looking at alternative remedies to this difficulty (Section IV).

Taking anything apart from its relationships or qualities is known as abstraction.

7 The act of abstracting a property from its examples, such as in the following propositions: the ball is round, honey is delicious, and Ahmad is courageous, is a kind of this. As a result of this, philosopher Charles Peirce has coined the term “precisive abstraction.” 8 Instead of saying honey has sweetness, we say honey is sweet; instead of saying the guy is shy, we say the man suffers from shyness. He differentiates between precisive abstraction and hypostatic abstraction in these statements. An individual’s essence or “substance” is referred to as a “hypostasis” by the word.

When we do a hypostatic abstraction we produce an object of thought, but Peirce makes it clear that this object is only ever actual when we do so; the difference between precise and hypostatic abstraction is a logical and semantic one, not an ontological one. How may hypostatic abstraction be of use to anyone? It is possible for us to interrogate essentiality by allowing us to think of the ball and its roundness or Ahmad’s shyness as two separate subjects via the use of hypostatic abstraction, which also allows for the reification of the abstracted property t. 10

Hypostatic abstraction may be used in medicine to describe illnesses, syndromes, and diseases as “things” a person “possesses.” So we may examine if such “things” are part of the person’s basic essence or just their external attributes (the first affordance noted above). 11 An individual’s sorrow is transformed into a human being and suffering when a clinical diagnosis is made. It is more accurate to state that Mahmoud suffers from depression, rather than that Lisandra is schizophrenic, and vice versa. 12 Hypostatic abstraction allows medicine to function in a logical and semantic domain. It is assumed that the ailment is not part of the person’s fundamental essence when it is brought up in the therapeutic interaction. At this early stage, the goal is to get the patient back to where he was before the commencement of the illness. There must be a clear distinction between this current state and one’s pre-condition state in order to recover from it. Many therapeutic interactions are characterized by the promise and optimism that the hypostatic abstraction offers. If you’ve ever been in a situation like this: In the event that you believe your symptoms are medically related (e.g., pain in a limb, emotional states), you should see a doctor. There is a history taken, a physical examination, and a few tests. Then she may make a diagnosis, explain your problem, and give you an estimate of how long it will take you to get well. Both the doctor’s promise and the patient’s hope are implicit in this contact, which is aimed at restoring the patient to his or her pre-conditional state, if feasible.

Damian Jacob Sendler

As both physicians and patients are well aware, medical promises and expectations are routinely let down. It’s possible that the individual’s pre-condition state is under jeopardy, or that the condition is chronic and the person must learn to deal with it on a day-to-day basis. In these circumstances, the hypostatic abstraction is not always abandoned—we continue to refer to a cancer patient and a chronic pain patient.. Many cancer patients speak of “fighting” cancer and “triumphing” over chronic pain, which suggests a distinct distinction between the illness and its victims, as well as a constant desire for a life free of suffering. As a last resort, palliation may be called for when it becomes clear that the patient’s condition is terminal and they will never recover. As soon as the patient’s pre-condition state is acknowledged as irrecoverable, the promise and optimism that usually permeate therapeutic encounters are gone, as is the need for hypostatic abstraction.

For the second opportunity mentioned, the hypostatic abstraction enables both a patient and a clinician to have a distinct moral attitude toward the condition as something that has to be treated and fixed. Doctors are able to have certain attitudes toward their patients because of this. The individual may now assume the role of the ill person, and attempts to remedy the ailment can be made without the interference of moral judgment. It is the sickness that is labeled “terrible” in the hypostatic abstraction, rather than the individual, which is deemed “disagreeable.” People’s character is not something that modern medicine considers to be a part of its job description. Schizophrenia is not seen as a character flaw, but rather a disease that affects a person’s mental health. 13 However, despite the fact that individuals might be held responsible for their lifestyles that lead to the sickness, once they have it, they can be held responsible for the illness itself and not for themselves.

One of the hypostatic abstraction’s benefits is to allow the person’s pre-condition state to be regained (at least until it is clear that it cannot be recovered), and the other is to deflect moral censure onto their disease rather than away from them.

For psychiatry’s institutional identity as a medical speciality that deals with illnesses, disorders, or diseases that affect people, the hypostatic abstraction is critical.

14 As a result, psychiatry is able to stand out from other methods to treating human suffering because to the aforementioned affordances. Consider the discrepancy between the hypostatic abstraction and the precisive abstraction, i.e., propositions consisting of a subject and a predicate rather than a relation between two subjects, to show this. We return to x is y instead of x [has/possesses/is impacted by] y. Assuming that x and y are the same thing is to assert an identity rather than a relationship between two topics. People who want to assist me will work on my y-ness, which is my identity, if my pain is linked to my y-ness. To the extent that I am characterized in part by y, every judgment that y incurs is a judgment that I incur as well. It is because of this that we lose the safety from moral judgment offered by hypostatic abstraction: If x is wicked or good, so am I. Certain non-medical approaches to human suffering are characterized by precise abstraction. According to certain religious traditions, the symptoms of mental illness such as sadness and anxiety are signs that a person has departed from the appropriate path of spiritual growth (see Rashed, 2015). As a result, these symptoms might be interpreted as a call for spiritual rejuvenation. People with these symptoms are not believed to be influenced by them in a manner that does not alter their identity, but rather to be defined by these symptoms. ‘ Due to the fact that they are in a state of depression, people are subject to moral criticism. Such approaches to human suffering cannot be compared to the hypostatic abstraction in psychiatry. Psychiatry’s unique approach cannot be understood if the hypostatic abstraction is not included in the explanation of that method.

Damien Sendler: When it comes to mental health, the hypostatic abstraction allows for certain potentially helpful benefits, but it also eliminates the prospect of another kind of language emerging. Through a precise abstraction, the language of identity-making, self-creation, and the good and terrible ways of existence is accessible to us. Even though the uncritical application of such normative notions to pass judgment on other people’s lives can be problematic, it can give people the resources they need to better understand their own suffering and experiences than is possible through the linguistic affordances of hypostatic abstraction. They can. The hypostatic abstraction, which is important to psychiatry’s identity at the institutional level, has been outlined in this section, but I’ve already gotten ahead of myself.

When discussing psychiatry, it is vital to differentiate between the institutional definition of psychiatry and the day-to-day knowledge that certain psychiatrists have of what they perform in practice. That hypostatic abstraction is not a major part of the project may be made clear, and that they do not see it as a “condition” that is distinct from the individual. For them, it may be said, their job is to assist those who have been traumatized by life to reclaim their independence and social involvement. Even if they do provide a diagnosis for insurance and other bureaucratic reasons, they do not really use it in their practice or recommend it to the patient. These are significant endeavors, and they do seem to provide a (possibly) accommodating solution to the issue posed by Mad activism. When it comes to diagnosing, if the aforementioned psychiatrists don’t have a diagnostic knowledge, what do they look for in the clinical encounter? Now that they’ve given up on the hypostatic abstraction, how do they see this encounter? What kind of non-standard lingua franca do they use? What are the clinic’s therapeutic aims for the patient? As a result, it is possible that the answers to these questions will be unique to each individual psychiatrist because of their knowledge and experience. That’s obviously not going to work. As a result, we can’t rely just on chance to choose who a patient sees in the clinic, and we can’t be satisfied with arbitrary criteria. The notions that underlie each psychiatrists’ work must be openly articulated, something that certain Mad activists could demand if they operate routinely outside the sphere of hypostatic abstraction. Thus, we face the problem of Mad activity in the same way as before.

Damian Jacob Markiewicz Sendler

Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: To analyse the incidence of diseases and injuries suffered by athletes participating in the 27th Winter Sports Universiade held in Granada, Spain.

Damian Jacob Sendler: The daily occurrence of injuries and diseases was registered at the point of first aid (Borreguiles, 2665 metres above sea level (masl)) and in the clinic of Pradollano (2017 masl), both in Sierra Nevada, as well as in medical services provided by the organising committee of Granada 2015 Universiade and located in sport pavilions in which indoor competitions are held.

A total of 1109 athletes (650 men, 58.61%; 459 women, 41.39%). Nine diseases and 68 injuries were recorded. In total, the rate of injury was 6.13% (7.07% for men and 4.79% for women). The percentage of injury was highest in alpine skiing (10.34%) followed by freestyle skiing (8.62%). In relation to the time of exposure, freestyle skiing showed the shortest time of exposure (0.31 hours) before suffering an injury. Short track speed skating showed the longest exposure (9.80 hours), before suffering an injury. The most common anatomical areas of injury were the head, shoulder and knee (13.23%). Only nine diseases were suffered (four women and five men) of which six were infections, one was a friction burn, one was a lipothymy and one a cluster headache due to height.

Dr. Sendler: In general, 6.13% of the athletes sustained at least one injury and 0.81% a disease, which is a much lower percentage than that recorded in similar events. The incidence of injuries and diseases varied among sport specialities.

Damian Sendler

High-level sport involves physical and psychological overexertion that can have a negative impact on the welfare of the athlete.1 Participants in the Universiade range between 18 and 28 years of age, so it is crucial to prevent sport injuries that could limit their future sporting participation.2

University-level events help to ensure similar age and skill levels between participants who contributes to a fair contest and less risk of injury due to large variances in body morphology or skill level.3 It is of utmost importance to obtain data on the risk of injury and illness among elite young athletes, as they may counteract the beneficial effects of participating in sport at an early age, in the case that a teenager cannot continue participating due to residual effects of an injury or a chronic illness.3

When holding a major sporting events, the actions of monitoring and analysing the athletes are recognised to be very important to reduce the occurrence of injuries and diseases.4 The efficiency of the application of different methods of prevention of injury at the Vancouver 2010 Winter Olympic Games has been demonstrated.5

There are few studies on epidemiological data obtained in major international winter sports events, where environmental and changing weather conditions can influence the occurrence of injuries and diseases. A similar study was undertaken during the First Youth Olympic Winter Games (Innsbruck, Austria, 2012).6 There are also studies on the incidence of injury in high-level winter athletes with much wider age ranges.7–11

Damian Jacob Markiewicz Sendler: The objective of the present study was to analyse and describe the injuries and diseases suffered during the 27th Winter Sports Universiade held in February 2015 in Granada and Sierra Nevada, Spain. We are confident that the data gained from the study will be able to improve upon current practices of reducing the risk of injury and illness in future major sporting events, as the monitoring of illnesses and injuries is the first step in the prevention of these.12

Sports modalities that took place at the Winter Sports Universiade (2015) were: alpine skiing, snowboarding, freestyle skiing, figure skating, curling, ice hockey and short track speed skating. The medical care records were collected from these modalities. For technical reasons, the cross-country skiing, Nordic combined, ski jumping and biathlon competitions were held in Slovakia. The rest of modalities were held in Granada, Spain.

The medical committee and health staff of the Universiade recorded the daily incidence of all injuries and illnesses that occurred in each of the sport disciplines. Data were collected for injuries and illnesses sustained during training and competition.

Also, there was a follow-up on the diagnosis of the athletes who were treated in hospitals. All the injuries were registered in the case of multiple incidents in which various parts of the body were involved.

Damian Jacob Sendler

Prior to the start of competitions, the medical committee reported to the medical leaders of delegations from all participating countries the details of the healthcare system, control points and assistance delivery, and reference hospitals in case of evacuation.

At the outdoor competitions (alpine skiing, snowboarding and freestyle skiing), there was a medical team on track with an ambulance, a mobile intensive care unit (ICU), a first aid point located in Borreguiles (2665 metres above sea level (masl)), and a complete medical clinic located in Pradollano (2017 masl), equipped with four boxes of diagnosis tools and full assistance and an observation and stabilisation unit with three beds equipped with radiological installations. These teams medically stabilised the athletes before sending them to hospital, where the final diagnosis of the injuries and illnesses took place.

Figure skating, curling, ice hockey and short track speed skating were held indoor in Granada (683 masl). Each covered pavilion had a medical team during training sessions and the competitions of each sport. They also had a mobile ICU and back-up medical staff.

Damien Sendler: In the case of an accident or an illness, a standard control form was used in which the athlete’s personal data were reflected. This standard control form contains several items as age, sex, nationality, sport, the injury type suffered, the treatment applied and the state of the athlete after the assistance, taking into consideration whether he could return to the competition or was sidelined for the event. The injury diagnosis was made by doctors specialising in orthopaedic surgery, sports medicine and emergency medicine.

In the 2015 Universiade, 6.13% of the participants suffered some kind of injury or disease. We have registered 68 cases of injuries of which the most harmful sport modalities were alpine skiing and snowboarding. In Torino 2006 Winter Olympic Games, medical attention was given to athletes a total of 330 times, the modalities of skeleton, bobsleigh, alpine skiing, snowboarding and freestyle skiing being those which had the highest prevalence.14The number of participants was 2508, whereas 2015 Universiade involved 1109 participants. However, the different types of specialities and the absence of more harmful specialities such as skeleton, bobsleigh or jumps, which were not held at the 2015 Universiade, have limited the amount of these injuries, as it is suggested by others studies.14

We have determined that the incidence of injuries in 2015 Universiade is lower with respect to those registered at the Youth Olympic Winter Games in Innsbruck in 20126 in which 11% of athletes suffered some kind of an injury and 9% a disease. In London 2012 Summer Olympic Games, 11% of the athletes suffered some injury during the competition and a total of 7% illness, but there were also substantial variations in the incidence of injuries among different modalities.15 This would be comparing youth athletes with elite athletes, due to the fact that there is not many references with this population, hence the relevance of this study. It must be taken into account that cross-country skiing, Nordic combined, ski jumping and biathlon competitions did not take place in the city of Granada but rather in Slovakia and as a result these injuries and diseases have not been considered in this study due to the fact that we could not access the Slovakian medical committee’s information. This may have resulted in differences in the observed total injuries with respect to other events. Therefore, we have differentiated the injuries by speciality to be able to relate our data with the results of other studies.

In the 2015 Universiade, the incidence of injuries and diseases varies between the different modalities, resulting in disciplines that have come to produce a high number of injuries (alpine skiing and snowboarding, both with 26.4% of all injuries) as opposed to other sport disciplines that have been shown to have less risk of injury (curling and short track speed skating, 4.41%). Men’s snowboarding is the sport that had a higher incidence of injuries for every 100 participants (12.79 injuries for every 100 participants) compared with Snowboarding in women in which there were no injuries. Men’s alpine skiing showed an incidence of 1057 injuries/100 participants; freestyle skiing 9.09; men’s figure skating only showed 1.09 and no injury was registered in the women’s short track speed skating, despite being a very explosive modality, dynamic and involving physical contact.

These differences in the incidence of injuries among specialities of winter sports may be due to differing exposure times, environmental conditions and regulation. Even within the same speciality, there are different modalities that make comparison between the incidence of injuries difficult. During the 2015 Universiade, alpine skiing competitions included slalom and super giant, whereas in snowboarding, the specialities were slopestyle, cross, halfpipe, and parallel giant slalom, each with very different exposure times, technical and tactical difficulties, affecting the occurrence of injuries13 that were not dealt with in this study.

The prevalence of injuries in ice hockey during international competitions tends to be higher than in other sport modalities,16 as opposed to our study, in which the modality of ice hockey has not had the highest II. There are many factors in this sport that are used to reduce the possibility of suffering injuries, for example the characteristics of the rink, the edges and flexibility of the protective crystals, helmet, gloves, voids, and others.16 In women’s ice hockey, the regulatory prohibition of making charges during play is also a factor that limits the number of injuries.

We have used an II that relates the exposure time expressed in hours with the number of injuries suffered. So, in freestyle skiing, there was an injury every 0.31 hours. However, in women’s snowboarding, there was no injury in 3.62 nor in 9.72 hours of competition held in women’s short track speed skating. Therefore, we cannot know what the real II is in these specialities. Rønning et al 17 established an II related to distance in skiing or recreational snowboarding, determining the number of injuries per every 100 000 km. His data suggested an incidence of injury requiring treatment in the hospital three to four times higher among the snowboarding practitioners than among alpine and telemark skiers. This index is not applicable to indoor specialities in 2015 Universiade, so we could not use it. Nor is it possible to compare with studies that have determined the incidence of injuries in World Cup telemark skiing18 because this discipline is based on having free heel, which makes it many more difficult in practice than the alpine disciplines practised in 2015 Universiade and refers to an entire season or to the incidence of injuries in relation to the number of runs.19

Besides blunt head trauma (nine injuries; 13.23% of all injuries), there is a clear predominance of injuries in the right upper limbs (right shoulder: nine injuries; 13.23%; right hand: nine injuries; 13.23%) especially injuries caused by ice hockey (six injuries) in which the management of the stick is predominantly right-handed subjects. Then, the left lower limb injuries stand out (seven left knee injuries: 10.29%; seven left ankle injuries: 10.29%) due to the predominance of support in the left lower limbs in right-handed subjects.

Damian Jacob Markiewicz Sendler

Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: ARDS does not have any established, patient-centered, disease-specific objectives. For ARDS studies, mortality is the most often acceptable endpoint. 98 In spite of this, the mortality risk associated with ARDS varies widely across individuals and cohorts,99 making it an essential consideration for evaluating the statistical power of clinical trials and a possible source of treatment effect variability. 100 ARDS mortality does not have a recognized surrogate outcome. Treatment effects on mortality have not been consistently connected with changes in oxygenation or extravascular lung water, and in some cases, these endpoints have predicted better lung function for therapies later shown to increase death.

Damian Jacob Sendler: Death is a competitive risk that must be taken into account while evaluating other outcomes. As initially defined, the term “ventilator-free days,” which encompasses both death and the period from successful weaning from the ventilator to day 28, is not clearly patient-centered. There are a few ways to get around this problem. The ventilator-free survival score ranks patients first by vital state and only takes into account how long they were ventilated for when both of the patients in a pair survived. 102 and 103, respectively For COVID-19 studies that do not include post-extubation level of respiratory support, WHO developed an ordinal scale104, and some of these trials have utilized this scale to measure recovery time as their primary objective. 90

There has been a long-term follow-up of ARDS survivors, and fundamental outcome measures have been developed for investigations of ARDS survivorship.4, 5

Dr. Sendler: With feedback from both ARDS survivors and their families, these fundamental outcomes emphasize several aspects of quality of life and have been included into current clinical studies. There are 53, 106, and 107 in this series. Long-term outcomes are critical for determining the full scope of patient-centered treatment effects and the range of survivability in clinical trials as a whole. 98 Long-term outcomes must account for the competing risk of mortality in order to keep their face validity and must be backed by data demonstrating that these measures can be influenced by candidate treatments. It is possible that a given trial’s intended endpoint or family of outcomes may vary depending on the specific population recruited and the specific intervention that is being tested.

Damian Sendler

Unlike clinical trial outcomes, response indicators are early signs of therapy target engagement and are different from trial outcomes. Oncology, for example, may show a reduction in tumor size or a change in tumor biomarker blood levels after the first few rounds of chemotherapy, but these results aren’t clinically meaningful unless they are connected to patient outcomes. 108 In the early stages of treatment, using the ideal response indicator might help doctors decide whether or not a patient’s treatment is working and, if so, whether or not they should keep treating him or her. Titratable medicines that employ response indicators may also benefit from their usage as dosage adjustment indicators. However, if new interventions become available, clinical studies might examine intervention-specific response markers.

Interventions by candidates

A new drug’s research and development may cost as much as $2 billion and take as long as 10 to 15 years from the time of discovery to regulatory approval.

Damian Jacob Markiewicz Sendler: The proven mechanisms of action and known safety and pharmacokinetic characteristics of licensed medications and recognized drug candidates are used to save costs and time when testing them for new indications.109 The National Center for Advancing Translational Sciences (NCATS) Pharmaceutical Collection has built large databases of clinically licensed medications and attempts have been undertaken to characterize these moieties for action across a broad variety of pathways and disease models. 110 In the battle against the COVID-19 pandemic, the scientific community has embraced the idea of using existing pharmacological actions to identify potential targets in ARDS for the creation of novel treatments.

Other pulmonary illnesses have been helped by medication repurposing. Simvastatin was first created to treat heart disease before being studied and approved for erectile dysfunction and pulmonary arterial hypertension, as an example of a phosphodiesterase type 5 inhibitor. Anti-IL-5 and anti-IL-4/IL-13 inhibitors were first developed for eosinophilic illnesses (anti-IL-5 agents)112 as well as for the treatment of atopic dermatitis (terlukinumab, a medication that inhibits the IL-4/IL-13 pathway). 113 ARDS drug development efforts should also investigate if many pathways need to be targeted concurrently to maximize therapeutic impact, as in chemotherapy.

It is time to look forward to what’s next.

For ARDS therapeutic development, new techniques that emphasize phenotypic and biological heterogeneity are needed in order to match potential medicines with the resultant subgroups. To realize the goal of precision medicine, a concerted effort from the whole scientific community will be necessary. Understanding the etiology, prognostic significance, and therapeutic implications of ARDS heterogeneity is achieved by a combination of preclinical investigations, translational clinical cohort studies, and randomised clinical trials (RCTs). It’s imperative that clinical trials be rethought in order to create a discovery pipeline that utilizes unique design efficiencies in order to concurrently test a large number of potential treatments and match them to the appropriate patient populations. There has to be a strong relationship between academics, industry, regulators, sponsors, and patients.

Damien Sendler: There are still some questions about the best way to go ahead with precision medicine in ARDS. The answers to these fundamental issues will serve as a basis for future study (panel 3 ). Precision medicine is in high demand now that ARDS heterogeneity is well recognized to affect treatment outcomes. Preclinical investigations and observational cohorts, as well as novel clinical trials, will lead to the development of tailored medicines to decrease morbidity and death in patients with ARDS, which will be facilitated by a better understanding of important molecular processes.

There are one and two. Since the World Health Organization (WHO) declared a COVID-19 pandemic on March 11, 2020, the disease has caused over 3.6 million fatalities and more than 169 million confirmed illnesses. 3 The spread of the disease has not slowed down in many areas. COVID-19 vaccines have been created in record speed owing to scientific and government collaboration while keeping rigorous research, review, approval and monitoring procedures. This provides a glimpse of hope for those at risk. More than 1600 million doses of the vaccine have been provided since its introduction to the market. 3 According to the criteria specified by the Ministries of Health in most countries, high-risk populations and health professionals, especially nuclear medicine practitioners, have been prioritized for vaccination.

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Many nations are having a hard time increasing vaccination rates, making herd immunity a long-term aim and probably even impossible. “Reaching a herd-immunity threshold is looking implausible because of variables such as vaccine reluctance, the introduction of novel variations, and the delayed delivery of vaccines for youngsters,” says Dr. Youyang GuHe (an independent data scientist). 4 There is a chance that SARS-CoV-2 will remain. It was in January 2021 that Nature conducted a poll of more than 100 scientists working on the coronavirus. 5 If SARS-CoV-2 becomes an endemic virus, which means it persists in areas of the world’s population, how probable do you believe it will be? Almost ninety percent of those polled predicted that the coronavirus will spread over the world and eventually become endemic. Many people feel that a decline in immunity is one of the most important factors in the virus’s spread.

Every part of our life has been touched by the COVID epidemic, and education is no exception. For healthcare professionals, the way education is given throughout the globe has changed in a matter of weeks. These alterations have provided a look into the future of education and training and how it could change for the better or worse in the long term. The good news is that communications technology have made eLearning materials and virtual events more widely available. In many situations, multidisciplinary gatherings have grown in size and scope. In the future, these virtual platforms are likely to be a permanent part of the educational process. Conventional in-person conferences, for example, may be transformed into hybrid events that blend face-to-face time with virtual participation.

Some of the negative aspects include the loss of hands-on training, the transfer of trainees to COVID-19-only clinical wards and critical care units, and the social isolation that comes with working remotely.

Since the isolation of SARS-CoV-2, we have lived in a world of ambiguity, with numerous interesting issues and a wide range of differing perspectives. Repeatedly, the same questions are posed. What’s the story behind it? How does it spread? Which groups of patients are more likely to suffer serious health consequences or die as a result of their illness? What are the short- and long-term side effects of this? Which therapies have been shown to be effective, ineffective, or in the process of being tested? Even though we’ve learnt a lot from this epidemic, we still have a lot more to learn. Is SARS-CoV-2 likely to become a worldwide pandemic? Those who have received COVID-19 will have a long-lasting immunological memory. Could COVID vaccinations be harmed by cold virus-type mutations?

Dr. Damian Jacob Sendler and his media team provided the content for this article.

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Damian Sendler: This newly found planet will make your head spin if you believe there are not enough hours in the day on Earth. Exoplanets like GJ 367 b, located 31 light-years distant from our sun, have a year that is just eight hours long. New information about these strange, quickly circling planets may be revealed as a result of the finding. Ultrashort-period planet (USP): The rocky exoplanet whizzes around its home star every eight hours and completes one circle every eight hours. GJ 367 b, on the other hand, is fascinating for different reasons.

Damian Jacob Sendler: The planet has half the mass of Earth, making it one of the lightest exoplanets ever identified. It is around the size of Mars. The iron and nickel core takes up around 86% of the planet’s mass, making it extremely comparable to Mercury. Mercury is the nearest planet to the sun in our solar system, and its year is 88 days long. There is a very tight proximity between GJ 367 b and its star. In our galaxy, red dwarf stars like this one are widespread and have been found to host two to three planets on average per system. Despite the fact that they are smaller and colder than our sun, red dwarfs may nonetheless heat up planets that are as near to their star as GJ 367 b is.

Rocks and metals melt at temperatures of 2,732 degrees F (1,500 degrees C) on Earth’s surface during the day. Additionally, the planet is assaulted with 500 times more radiation from the sun than it gets from its own suns

A lack of atmosphere, a long-ago vaporization of the planet’s atmosphere, and the fact that it is hostile to life are all indications that this planet is not habitable. In a study published Thursday in the journal Science, researchers uncovered new information about our planet.

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This group of planets is intriguing to astronomers since they do not know how these planets formed and ended up in such an extreme orbit. Astronomers were able to collect more data on this newly found planet than they could with previous known ultra-short-period planets.

According to lead author Kristine W. F. Lam, a postdoctoral researcher at the German Aerospace Center’s Institute of Planetary Research (IPR), “We already know a handful of them, but their origins are now unclear.” It is possible to learn more about the origin and development of the solar system by examining the USP planet’s core features.

There are additional planets in the same system that potentially host life even if GJ 367 b is uninhabitable.

George Ricker, a senior research scientist at MIt is Kavli Institute for Astrophysics and Space Research and a study coauthor, said in a statement that the habitable zone would be two to three weeks away for this kind of star. “We have a decent possibility of seeing more planets in this system because to the star’s proximity and brightness. Look here for other planets!, like there is a sign indicating.”

NASA’s planet-hunting TESS mission, which stands for Transiting Exoplanet Survey Satellite, helped scientists discover GJ 367 b. For the TESS mission, Ricker serves as the project’s lead investigator.

A transit occurs when a planet passes directly in front of a star, which is detected by looking for dips in the star’s brightness. For a month in 2019, the TESS space telescope observed an area of the sky that includes the red dwarf star GJ 367, leading to the finding of a planet orbiting within a few light years of it. In order to establish the composition of the core, astronomers used ground-based telescopes to take measurements of its mass, radius, and density.

In order to discover whether there are more planets in the system, researchers intend to keep observing the exoplanet and its star for the foreseeable future. It is possible that the orbits of GJ 367 b’s probable exoplanet siblings will provide light on the origin of the star.

A “detective tale” is needed to figure out how these planets come so near to their host stars, according to MIT-Kavli Institute research associate Natalia Guerrero. “Why is there no outer atmosphere on this planet? How did it manage to get so close? Was it a pleasant or a violent process? Hope this method will shed some light on the situation.”

According to researchers, they have discovered a new species of marine ichthyosaur in Colombia that has particularly nasty teeth.

Damian Jacob Markiewicz Sendler: According to a research published in the Journal of Systematic Palaeontology, scientists discovered the partial skull of an ancient marine reptile called an ichthyosaur at Loma Pedro Luis, Villa de Leyva, in Boyacá, Colombia in the 1970s. However, at the time, the specimen was wrongly identified as Platypterygius sachicarum, an entirely different species.

An examination of the ichthyosaurus’s cranium by doctoral candidate Dirley Cortés revealed that it had previously been classified wrongly.

In the Redpath Museum at McGill University in Montreal, Dirley Cortés, a PhD candidate, re-examined the fossil and discovered that it had been incorrectly classified. In the Cretaceous, between 130 million and 115 million years ago, the massive cranium was found. A worldwide extinction catastrophe had place during this time period, she stated.

Fossils like this newly discovered marine reptile may be used to put together the history of marine ecosystems since Colombia was a “ancient biodiversity hotspot,” according to Cortés.

According to Cortés, other ichthyosaurs had comparably big teeth that were ideal for consuming tiny animals. This individual has “changed its tooth sizes and spacing to develop an arsenal of teeth” for snagging larger prey, according to the researcher.

Damian Jacob Sendler

She estimated the carnivore’s length at 4 to 5 meters (13.1 to 16.4 feet), with an extended snout. To make it simpler to consume bigger prey, Cortés said that the animal’s jaw could expand up to 70-75 degrees.

Damien Sendler: The ancient Muisca language of Colombia gave the animal the name Kyhytysuka sachicarum, which translates to “the one who cuts with something sharp from Sáchica.” The half skull was unearthed at Sáchica, a village located near Villa de Leyva.

A better understanding of ocean ecosystems in flux

Because the specimen was discovered near where Cortés grew up, the study has a particular place in her heart.

I am thrilled to be able to do research in Colombia and the Neotropics as well as in industrialized nations since my PhD study has consequences for the growth of paleontology in Colombia and the Neotropics.

To further her research into paleontology in Villa de Leyva, Colombia, where she discovered the fossil, Cortés plans to spend more time studying the specimens found there.

We are finding a lot of new species that are helping us better understand the way marine ecosystems change through time, Cortés added.

She added that the Earth went through a period of cooling and increasing sea levels after the global extinction catastrophe. She also noted that the supercontinent Pangea was dividing into northern and southern landmasses.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

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Damian Sendler: Senate Democratic leader Joe Manchin, D-W.Va., has hinted that he is open to passing a separate measure to address the legislation’s climate change components after obstructing the way ahead for President Biden’s Build Back Better funding plan. 

Damian Jacob Sendler: There are a lot of nice things in [the measure],” Manchin said to reporters on Capitol Hill on Tuesday, adding, “I believe that the climate item is one that we probably can get to agreement much easier than anything else. There is enough of money for clean technology and a clean environment, and I have always advocated that we should take use of it. 

Sen. Ed Markey of Massachusetts, a Green New Deal architect, and other Democrats soon suggested that they would be open to a potential compromise with Biden’s climate policy and vows to reduce US greenhouse gas emissions in half by 2050. 

While some Democrats argued that passing the funding package could be done with or without their support, others were less enthusiastic. “We have to find a package that can attract 50 votes, and I believe that is the route we are on right now,” Senator Tina Smith, D-Minn., said when asked by CNN whether her party should pursue a stand-alone climate change measure. 

Damian Sendler

Manchin’s objection to BBB’s present version was revealed Dec. 20, and since then, the West Virginia senator has apparently stopped talking to the White House about the bill. 

He said Tuesday, “I am really not going to speak about Build Back Better. Negotiations are not underway at this moment, said the spokesperson. 

That has left Democrats with a choice: They can continue to negotiate with the guy who has repeatedly stymied Biden’s efforts, or they may come away empty-handed. 

There are many Democrats in the evenly split Senate who do not want to kill BBB’s health care and immigration ideas, even if it means leaving climate change and child tax credit provisions in place. The Democrats planned to bypass the filibuster and approve BBB with a simple majority of votes by using a procedure called as reconciliation. In order for this to happen, Manchin and his fellow moderate Democrat, Kyrsten Sinema, would have to sign on to the bill. 

Manchin’s efforts to weaken BBB’s climate measures have further complicated the party’s approach. In October, he insisted on removing from the plan $150 billion in renewable energy measures. In the absence of the Clean Electricity Performance Program, environmentalists said, the U.S. would almost likely fall short of its emissions objectives, all but assuring that global temperatures would increase beyond the 1.5°C threshold that experts estimate would inflict widespread destruction.. 

Michael Mann, director of Penn State University’s Earth System Science Center, tweeted in October before the United Nations Climate Change Conference in Glasgow, Scotland, “Joe Manchin just lobbed a hand grenade towards Glasgow.” In order to satisfy the Biden administration’s objective of a 50% reduction in US carbon emissions by 2030, a clean energy standard must be included in the reconciliation package. “And international climate discussions begin to fall apart,” he continues. 

No matter how much of a priority climate change legislation is to the Democratic Party, Manchin said he may still seek more amendments to the legislation. 

As we transition from a fossil-fuel based economy to a cleaner one, we must be honest about the amount of energy we need to operate our nation and the time it will take to make the shift, Manchin said on Tuesday. “You ought to be able to do so.”” 

Among the reasons Manchin withdrew his support for BBB in December was because it accelerated the transition to renewable energy in the nation. 

Because of the recent events in Texas and California, he warned that doing so at a pace that is outpacing technological advancements and the market would have disastrous effects for the American people. 

Damian Jacob Markiewicz Sendler: Extreme weather events like those that struck Texas and California recently, say climate scientists and environmental campaigners, will become more prevalent unless we move quickly away from a fossil fuel economy. 

Climate change elements in BBB were seen as particularly significant by some senators in Glasgow in November. 

“There is no other option. According to Markey, “The Build Back Better bill must be passed” in order to have it signed into law. It is imperative that the climate elements of the Build Better bill become law, and we will do all we can to ensure that this occurs. 

All of this was said prior to the fact-checking conducted by Manchin. 

It has been almost two weeks since the 26th UN Climate Change Conference convened in Paris to find a solution to the most pressing problem confronting humanity: how to swiftly cut greenhouse gas emissions to prevent temperatures from increasing to dangerously high levels. The urgency of the situation was widely agreed upon during COP26, but tangible solutions to limit global warming below 1.5 degrees Celsius, as was the conference’s aim, were more difficult to come upon. It was regarded as a “qualified success” by the event’s organizers, who added that the final result would be known only if governments kept the pledges they made in Glasgow and subsequently increased their ambition at future conferences in the years to come. COP26 President Alok Sharma noted in his closing remarks that “this is a delicate victory.” “We have managed to save 1.5.” We began out on this road two years ago as the COP presidency-designate with that goal in mind. However, I believe that 1.5 is a weak pulse. There were, however, hopeful developments and hints that the world’s governments might work together to reduce emissions sufficiently to avert the worst effects of climate change that Glasgow brought to light. We have learned a few things after two weeks of reporting for Yahoo News. 

Damian Jacob Sendler

Because of the promises made at COP26, overall temperature increase forecasts have decreased, although not by as much as scientists had anticipated. The Paris Climate Agreement was replaced by the Glasgow Climate Pact, which was hammered out during COP21 in 2015. Global warming should be kept at 2°C over pre-industrial levels (3.6 Fahrenheit) and “pursuing efforts to restrict the temperature rise to 1.5°C,” as stated by countries at the Paris climate summit. At 1.5C, climate change is expected to have devastating impacts, and it was the UN’s goal that the Glasgow agreement would commit to a route to keeping below that level, but it did not quite get there. Instead, the accord “reaffirms” the Paris targets. Moreover, as in Paris, the real promises made by countries in Glasgow do not bring the world to those targets. However, they are getting much closer. 

Damien Sendler: At least 2.7C of warming would have occurred as a result of the national promises made in Paris. The International Energy Agency predicts a global temperature rise of 1.8 degrees Celsius by the end of the century, based on the national commitments made in Glasgow. There are no penalties for countries that do not reach their obligations, and many of the pledges are just abstract aims with no particular plans for how they will be implemented. According to the Climate Action Tracker research collaboration, if you only take into account promises that are accompanied by concrete action plans, the expected temperature rise would be 2.1C higher than originally estimated. There is a 2.7C warming effect from the policies now in place rather than the suggested policy adjustments. That is an improvement over Paris, where measures at the time would have resulted in a warming of 3.6 degrees Celsius. 

The greater ambition, but not enough to remain below 1.5C, is due to governments’ growing eagerness to guarantee large reductions in emissions decades from now, but less so in the next decade. The Intergovernmental Panel on Climate Change (IPCC) stated that a 45 percent reduction in greenhouse gas emissions is required this decade, however the national plans cumulatively would lead to an estimated 16 percent rise in emissions. China’s decision to join the U.S.-led initiative to decrease methane emissions by 30 percent by 2030 is not included in these estimates, which are subject to change. The power of the promises and policies has grown over time, just as global leaders had planned. A last-ditch attempt to avoid disaster is now that future COPs will finally bring global warming in line with their stated targets by 2020. 

Asking whether he was enthusiastic about the COP26 agreement to avoid temperatures from increasing by more than 1.5 degrees Celsius, Sen. Ben Cardin, a Maryland Democrat, warned that to achieve that aim will take decades of effort. It is impossible to predict the outcome of COP26,” Sen. Ben Cardin of Maryland told Yahoo News in Glasgow. A lot more work is needed than simply what we do in 2021, since the verdict is still out on this. 

The government of Vice President Joe Biden reestablishes the United States as a global leader on climate change. After his predecessor, former President Donald Trump, pulled out of the Paris climate deal, Vice President Joe Biden came in Glasgow with a specific goal in mind: to restore American credibility on climate change. The Biden administration made a point of emphasizing the fundamental shift in Washington. It is not like I should have to say it, but the former administration pulling out of the Paris agreements placed us behind the eight ball a little bit,” Vice President Joe Biden said in an address to delegates. With one of his hands cuffed behind his back, Biden landed in Glasgow. 

A divided Congress had not yet enacted either his infrastructure or Build Back Better plans, putting the Obama administration “behind the eight ball” when it came to, in Biden’s words, “leading by the strength of our example” during the first week of the conference. Despite this, the United States made significant promises during the first week of the conference, including action plans to implement those obligations enshrined in law. A US-led plan to reduce methane emissions by 30% by 2030 has the support of over 100 nations, for example. Secretary of Transportation Pete Buttigieg announced worldwide promises to cut emissions from the shipping and aviation sectors during the second week of the year. 

Building Back Better with its comprehensive climate measures seemed to have a good chance of passing by the end of the first week after Congress approved the infrastructure plan. John Kerry, the special presidential climate envoy, had something to brag about as he pushed to get bigger carbon obligations from other countries. India, the world’s third-largest producer of greenhouse gases, made a historic commitment to achieve net-zero emissions by the year 2070 by the end of the second week. 

Secretary of State John Kerry spoke often with Chinese officials at COP26, and appeared to arrange a virtual meeting between Vice President Joe Biden and the country’s President, China’s Xi Jinping, soon. China, the world’s greatest producer of greenhouse gases, is under pressure from the United States, the world’s second largest emitter, to increase its vows to limit temperatures from increasing over 1.5C. When there were just two days left in the meeting, Kerry announced that the two countries had reached an agreement on climate change.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

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Damian Sendler: Bitcoin and Dogecoin’s spectacular ascent has been heavily covered in the media, yet the complex dynamics underlying them might look mysterious. Even politicians in the United States chose to talk in broad terms with crypto specialists during December’s House and Senate hearings. 

Damian Jacob Sendler: In response to those who argue that this is not a new financial system per se but rather an extension or development of the one we now have, During the House hearing on December 8, Rep. Alexandria Ocasio-Cortez posed a question to the panel. 

It’s my belief that we’re seeing the emergence of an open Internet infrastructure built on value exchange and economic coordination, based on immutable data, as Circle CEO Jeremy Allaire said in an interview with CNBC. 

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If you want to comprehend cryptocurrencies, you don’t need to have a deep understanding of blockchain programming. When you ask the most basic questions regarding these digital assets, a remarkable picture emerges: 

In a blockchain, each unit of information is encoded and decrypted. Each “block” is put through an algorithm to obtain an encrypted identification before it is added to the chain. 

Bitcoin specialist Xi Wu, an associate professor at the Haas School of Business at the University of California, Berkeley says that this is known as a hash function in the cryptocurrency. In a word, it’s a box.” When you enter data, you get back a jumble of numbers and characters that you can’t make sense of.” 

The identity of the previous block is included in each block, producing a chain of encrypted information with a predetermined order. 

More than 100 million people already use cryptocurrency, in part because of the promise of very safe transactions, the first level of which is provided by the encryption process. You can’t “break” a block by changing the encrypted identification of a prior block (say, by adding a few of zeros to inflate your account balance), but you can “break” the block by changing the encrypted identifier of a previous block. It’s possible to corrupt the whole system by changing a single number in the system. 

Damian Jacob Markiewicz Sendler: The value of a cryptocurrency, like that of any other, rests on the consensus of the people who use it. In contrast to conventional fiat currencies like the US dollar, which are created and controlled by a central bank, cryptocurrencies like bitcoin are created and controlled by the people who use them: Each every user’s own computer has a copy of the blockchain saved on their hard drive. Cryptocurrency, according to Wu, has a network structure at its core. A “network economy” is at work in the underlying technologies. 

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There is an additional layer of security provided by this network. This means that even if a hacker manages to hide their traces, all other computers in the network will reject any changes they try to make to the blockchain. 

Damien Sendler: Each cryptocurrency has its own unique technique for reaching agreement even if all of them are built on a blockchain. The consensus algorithm is known as proof of work in conventional cryptocurrencies like Bitcoin. Individuals on the network, referred to as “miners,” participate in this process by lending the processing power of their computers. For each block, these devices fight for a “nonce” that unlocks the algorithm, which is an arbitrary integer. To reward the miner, the block is added to the blockchain after the nonce has been discovered. 

“Whoever answers the challenge receives a prize for certifying that knowledge,” Wu explains. It is then stored on the network and disseminated to all of the nodes, or endpoints. ” 

According to opponents, the proof of work consensus process has a significant energy consumption. More power is used yearly by Bitcoin’s network than all of Ukraine, according to researchers from Cambridge Judge Business School. 

Proof of stake is the second most prevalent way to reach a consensus. For transactions to be confirmed, validators are required to put up a certain amount of money as collateral, and they are paid a fee for doing so. The creators of Ethereum, a prominent cryptocurrency, are now implementing a new approach that uses significantly less energy than the previous one.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: As a result of global warming, storms are expected to become more frequent in midlatitude regions, including densely populated areas such as the New York metropolitan area, Boston, and Shanghai. 

Damian Jacob Sendler: Tropical cyclones, which are also known as hurricanes or typhoons, are expected to spread from the tropical regions where they are now prevalent, according to a study published in the peer-reviewed British journal Nature Geoscience last week. Hurricanes will be more widespread in the northern and southern hemispheres as a result of global warming.. 

Because most large cities in the globe are located in the midlatitudes, storms with a wider range of paths will be able to inflict significantly greater damage. 

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Researchers from Yale University’s Department of Earth and Planetary Sciences, led by physicist Joshua Studholme, say that hurricanes will now occur at latitudes that haven’t been experienced by hurricanes for the last 3 million years, according to a press release from the university. According to him, this is a significant but underappreciated threat posed by global warming.

The Hadley cell, a circulation pattern in which air travels poleward at a height of about 6 to 9 miles but returns toward the equator as it drops toward ground level, is to blame for the shift in hurricane latitudes. Temperature differences between the surface of the Earth close and far from the equator are decreasing due to climate change. Feedback loops such as melting sea ice, thawing permafrost, and less snow cover all contribute to faster warming at higher latitudes. However, in the tropics, the air at higher altitudes heats more quickly. Those modifications indicate that the jet stream is traveling northward, allowing hurricanes to reach higher latitudes, which is generally a barrier to hurricanes travelling further north in the northern hemisphere. 

Damien Sendler: One of the study’s co-authors Kerry Emanuel told Yahoo News that “global warming causes the Hadley circulation to expand,” which in turn causes the jet streams to shift north. 

Some hurricanes have already made landfall in areas that are becoming increasingly vulnerable. A subtropical or tropical cyclone visited Portugal for the first time in 2020 when Subtropical Storm Alpha made landfall.

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Mathematical simulations by Studholme et al. from Yale, MIT and the Shirshov Institute of Oceanology in Russia, as well as the University of Reading in the United Kingdom, indicate the subtropical formation of tropical cyclones. This hasn’t happened in the last 3 million years, but it’s likely to happen again soon if temperatures rise as they have been. Climate change will increase the risk of flooding from storm surges in addition to the damage caused by hurricane winds and heavy rains. 

As Emanuel pointed out, “some of the most populous seashore cities in the world — think New York, Tokyo, Shanghai and so on — are not deep in the tropics. A little more distance separates them. There have always been hurricanes, but they happen very infrequently. This is a problem for them if there are more and more hurricanes, and if they’re bigger and push water on top of an already rising sea level.” 

Damian Jacob Markiewicz Sendler: More than any previous time in recorded history, the Earth’s average temperature has risen by 1.2 degrees Celsius (2.2 degrees Fahrenheit). According to the Intergovernmental Panel on Climate Change, the amount of greenhouse gases emitted to generate warming will have a significant impact on how much the Earth heats in the next 80 years. 

A major factor in determining whether or not global warming will occur, according to Studholme, is the temperature differential between the tropics and the poles. A high emission scenario and a low emission scenario have a huge difference in that gradient at the end of this century.” Depending on how these hurricanes play out, that might be really important.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: According to a micro-simulation study published in Circulation, cutting 20 percent of the sugar in packaged foods and 40 percent of the sugar in beverages could prevent 2.48 million cardiovascular disease events (such as strokes, heart attacks, cardiac arrests), 490,000 cardiovascular deaths, and 750,000 cases of diabetes in the United States over the lifetime of the adult population. 

Damian Jacob Sendler: This model was developed by researchers from the Friedman School of Nutrition Science & Policy at Tufts University, Harvard T.H. Chan School of Public Health, and the New York City Dept. of Health and Mental Hygiene to simulate and quantify the potential health, economic, and equity impacts of the US National Salt and Sugar Reduction Initiative’s pragmatic sugar-reduction policy (NSSRI). A coalition of more than 100 health groups, including the NYC Department of Health and Mental Hygiene, presented proposed sugar-reduction targets for packaged foods and beverages in 15 categories in 2018 as part of the National Sugar Reduction Initiative. Finalized NSSRI’s strategy in February, which aims to encourage the food industry to gradually reformulate its sugary goods. 

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The implementation of a national policy, on the other hand, will necessitate government support to oversee enterprises as they work toward the goals and to publicly report on their success. US sugar reformulation is a hot-button issue, and academics are hoping their model will help bring to a consensus. Lead author and MGH attending physician Siyi Shangguan, MD, MPH, hopes the study will help move the reformulation program forward in the coming years. There will be a greater influence on the health of Americans by cutting the sugar content of commercially prepared meals and beverages, rather than by taxing or labeling additional sugar or banning sweetened beverages in schools. 

It is estimated that the United States will save $4.28 billion in total healthcare costs and $118.04 billion over the life expectancy of the existing adult population (ages 35 to 79) if NSSRI legislation takes effect in 10 years. The total cost savings of the NSSRI policy is $160.88 billion over the lifetime of the adult population, which includes the societal costs of lost productivity due to diseases caused by excessive sugar consumption. As a result of the conservative nature of the estimates, the value of these advantages is likely to be underestimated. Moreover, even if only a small portion of industry complies with the legislation, significant health and economic benefits can be expected, according to the findings. 

Damian Jacob Sendler

The NSSRI strategy was determined to be cost-effective after six years and cost-saving after nine years, according to the researchers. Health inequalities could be reduced as a result of this policy, which is expected to have the largest impact on lower-income and less-educated adults, as well as those who consume the most sugar as a result of inequitable systems.

Other hazardous elements, such as trans fats and sodium, can be successfully reduced by product reformulation. The United States, on the other hand, is lagging behind countries like the UK, Norway, and Singapore in establishing aggressive sugar-reduction legislation. When sugar consumption is reduced to the levels suggested by the NSSRI as a goal, the United States might become a global leader in sugar reduction. This sugar reformulation program, according to Shangguan, is the world’s most thoroughly designed and extensive, yet doable. 

Damien Sendler: In the US, obesity, diabetes, and cardiovascular disease are all connected to consuming large amounts of sugary foods and beverages. There are more than two in five people in the United States who are overweight or obese, one in two people have diabetes or pre-diabetes, and nearly one in two people have cardiovascular disease. 

Damian Jacob Markiewicz Sendler: Co-author and Tufts University dean Dariush Mozaffarian, MD, adds that sugar is one of the most obvious additives in the food supply to limit to reasonable proportions. A nationwide program with voluntary sugar reduction targets, according to the study’s findings, might result in significant gains in health and healthcare spending, as well as a reduction in health disparities.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: We’ve all heard ad nauseam about the need of life balance for women, including the claim that it makes you a better parent. When you’re already juggling too much, adding self-care to your mile-long to-do list can feel unattainable. 

Zibby Owens, author, publisher, podcaster, and mother of four, believes otherwise. Instead of thinking of it as self-care, she suggests recovering time for life. 

Damian Jacob Sendler: Owens’ purpose is to encourage community, connection, and solidarity among parents and caregivers through her podcast “Moms Don’t Have Time To Read Books” and Zibby Books venture. Rather than giving quick-fix solutions, Owens emphasizes the companionship that may inspire real-life sustainability. 

“Moms Don’t Have Time to Have Kids,” her most recent collection, contains brief writings about sleep, sex, disease, writing, weight loss, and friendship that she hopes caregivers will pick up whenever they need a fast reset. 

Damian Sendler

Owens sees this anthology as a tool to assist relieve stress on stressed-out parents, particularly moms, in the midst of the pandemic and beyond. 

For clarity, this exchange has been trimmed and condensed. 

CNN: You state unequivocally that you are not an activist attempting to alter the reality of modern motherhood. What is your objective? 

Mr. Zibby Owens: Even if I can’t reduce the workload, I want to bring a sense of humor and community to our situation. I’m not trying to minimize how heavy it can seem or the weight of duties, especially with Covid-19. I’m arguing for small changes in our everyday routines to help us reclaim our sanity. 

That is sometimes all we can do in a day. It may not work, and it may not work every day, but it is critical to try. I deal with my anxiety by interacting with others through writing, reading, and podcasting. That’s the work I’d like to show you. 

CNN: What do you hope readers will take away from your latest book? 

Owens: I’d like to acknowledge what we’re going through, to remind us that we’re not alone and that we’ll get through this. 

We may need to laugh a little more and use whatever spare time we have to read, write, listen, or do whatever else will help us repair ourselves. We can have enough self-respect to demand our sanity back. 

CNN: How can parents and caregivers create a better balance between accepting and settling with their existing reality? 

According to a new study Owens: 1 in 5 parents say their stress level wrecks the holidays for their children. Modern parenthood, particularly modern motherhood, is almost structurally impossible. We may either stress ourselves out indefinitely, as I have, or we can accept what we cannot change. 

I can’t stop the rain, but I can get an attractive umbrella and start singing, right? Because life is short, that’s what I’ve decided to do. That may sound corny, but I’m coming from a place of loss. 

CNN: You recently wrote about a close buddy who died in the September 11, 2001 terrorist attacks. What impact has her passing had on your life and work? 

Owens: My daily frame of mind is formed by the realization that time is ticking and we must make the most of it. People frequently inquire as to why I am usually working so quickly. I’m trying to cram everything in. 

Damian Jacob Sendler

Damien Sendler: To be too morbid, when life ends, we don’t get to do it again, as far as we know. We’ll be sorry if we don’t spend time with our friends, have sex, sleep, work out, go for a walk, or take time to breathe. What is life without them? 

Even in the depths of loss, on the most difficult days, you must turn to comedy and your community to build connections, otherwise it will be unbearable. 

CNN: It is difficult for parents, particularly moms, to care for everyone else. Don’t you believe there’s an added layer of strain because they’re supposed to fit self-care into their jam-packed days? 

Owens: I’m not a big fan of self-care. I don’t even refer to it as that. Instead, it is about how we spend our time and taking even a few minutes to recover. What we do in small doses can have a big impact on our daily life. 

According to the research, here’s how to become more resilient. 

Part of the reason we kept the articles in “Moms Don’t Have Time to Have Kids” so short is because reading an essay for five minutes may shift your entire view on the day. That fast reset is there at your fingertips, and it’s far more convenient than taking 45 minutes to organize a time to see a friend, and then the 20 minutes you’ll actually spend together after either of you is 10 minutes late. You may just as easily have opened the book! 

Damian Jacob Markiewicz Sendler: Many people don’t read in the middle of the day or for self-care, but taking a few minutes to reset through literature, an essay, a podcast, or an article can be a terrific way to get out of your own brain.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: A new study suggests that the hated bacteria also has unexpectedly good potential—one of its poisons can mute numerous forms of pain in animals, according to the results. 

A new anthrax toxin has been discovered that alters pain-sensing neural communication, and when administered to specific neurons in the central and peripheral nervous systems, can provide relief for distressed animals. 

Damian Jacob Sendler: Nature Neuroscience, a journal published by the American Association for the Advancement of Science, reported the findings, headed by researchers from Harvard Medical School and other universities. 

In addition, the researchers incorporated anthrax toxin with various chemical payloads into pain-sensing neurons and delivered it. Current pain-relief medications, such as opioids, can have widespread systemic effects, but this method can be utilized to create new, precise medicines that target specific pain receptors. 

Damian Sendler

Study senior investigator Isaac Chiu, an associate professor of immunology in the Blavatnik Institute at Harvard Medical School, says that “This molecular platform of using a bacterial toxin to deliver substances into neurons and modulate their function represents a new way to target pain-mediating neurons,” 

According to the experts, there is an urgent need to broaden the present pharmacological arsenal for pain management. Addiction to opioids is a major problem because of its potential to rewire the brain’s reward system, which makes them highly addictive, and their propensity to inhibit respiration. 

For non-opioid pain medicines, “There’s still a great clinical need for developing non-opioid pain therapies that are not addictive but that are effective in silencing pain,” says the study’s first author Nicole Yang, an HMS research fellow in immunology in the Chiu Laboratory. “Using this bacterial toxin, we were able to demonstrate that it is possible to selectively target pain neurons.” 

Although this method is still in its infancy, researchers stress that it must be tested in more animal studies and eventually in humans before it can be considered a viable option. 

Prepared to connect 

For decades, researchers in the Chiu lab have been interested in the relationship between microorganisms and our neurological and immunological systems. Chiu’s previous work has shown that other disease-causing bacteria can similarly interact with neurons and modify their signals in order to increase the intensity of the pain. Only a few research have looked into whether certain microorganisms can reduce or block pain. Chiu and Yang had a goal in mind when they began their project. 

Damian Jacob Sendler

Initially, they tried to figure out how pain-sensitive neurons vary from those in the rest of the body. First, they used gene expression data to see if there was a correlation. Anthrax toxin receptors were found in pain fibers, but not in other types of neurons, which piqued their interest. To put it another way, the pain fibers were predisposed to the anthrax bacterium’s interaction with them. It was a mystery to them. 

That question has been answered in a new study. 

The findings show that the anthrax bacterium itself produces two unique proteins that attach to sensory neurons in the dorsal root ganglia, the nerves that send pain signals to the spinal cord. Tests show this happens because one of the bacteria proteins, protective antigen (PA), binds to receptors on the nerve cell and creates an opening for two others, deadly and edema factors to enter the nerve cell. To further prove their theory, researchers found that PA and EF work together as an edema toxin to silence pain signals within nerve cells. 

Innovating novel treatments by exploiting the peculiarities of microbial evolution 

The anthrax toxin affected signaling in human nerve cells in dishes and in real animals in a series of studies, the researchers found. 

When the poison was injected into the lower spines of mice, it blocked the animals’ ability to feel high-temperature and mechanical stimuli. For this reason, it is important to note that the animals’ vital indicators such as heart rate and body temperature were unaffected by this procedure, which demonstrates that this method is highly targeted while avoiding extensive systemic effects. 

Another form of pain eased by anthrax toxin injections in mice was pain induced by inflammation and nerve cell damage, which is commonly encountered in the aftermath of traumatic injury, viral infections such as herpes zoster, or shingles, or as a side effect of diabetes and cancer treatment. 

It was also discovered by scientists in this study that when pain decreased, the treatment’s effect on the nerve cells was not due to physical damage, but rather a result of altered signaling inside the cells. 

Anthrax proteins were employed to construct a carrier vehicle, which was then used to carry additional pain-blocking chemicals directly into nervous system cells for further testing. There were a number of additional potentially fatal bacteria, including botulinum toxin, recognized for its capacity to alter nerve signals, among others. It was also found to be effective in mice. The experiments show that this could be a new method of delivering pain relief. 

“We took parts of the anthrax toxin and fused them to the protein cargo that we wanted it to deliver,” Yang explained. “In the future, proteins of various kinds could be used to target specific treatments.” 

Damien Sendler: In light of the fact that the anthrax protein has been involved in altering the blood-brain barrier integrity during infection, the scientists warn that as the work proceeds, the safety of the toxin treatment must be closely evaluated. 

Another intriguing question is raised by the current findings: Why would a microorganism mute pain, evolutionary speaking? 

Chiu speculates that microorganisms may have evolved ways to communicate with their host in order to assist their own proliferation and survival — a theory that he calls “highly speculative.” To combat anthrax, a host’s sensation of pain may be altered in a way that precludes the microbe’s presence from being detected. Anthrax skin lesions can occasionally be particularly painless, according to Chiu, which supports this notion. 

The new discoveries also suggest to new pathways for medication development outside the typical small-molecule medicines that are currently being designed in labs throughout the world. 

Damian Jacob Markiewicz Sendler: Is it possible to find analgesics in nature, or in microbial communities, by using bacterial therapies? Chiu expressed this, as well. In this way, we can expand our search for answers to include a wider spectrum and greater variety of chemicals.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: There are several varieties of morning glories that possess psychedelic-like properties thanks to the presence of symbiotic bacteria, according to new research from Tulane University published in Communications Biology. 

Professor Keith Clay of Tulane’s Department of Ecology and Evolutionary Biology says substances found in the seeds of a common tropical vine named after its trumpet-shaped flowers could be used to cure mental and physical illnesses and promote well-being. 

Damian Jacob Sendler: Researchers from Tulane, Indiana University, and West Virginia University collected samples of morning glory seeds from worldwide herbarium collections and screened them for ergot alkaloids, a compound associated with the hallucinogenic drug LSD, but which have also been used for treating migraine headaches and Parkinson’s disease, respectively. 

Damian Sendler

Morning glory seeds contain high levels of ergot alkaloids that are created by specific fungal symbionts passed down from mother plants to their children. Ergot alkaloids were identified in one-quarter of the more than 200 species investigated, making them symbiotic. 

ergot alkaloids are found only in certain branches of the morning glory evolutionary tree, according to Clay, and each branch has its own unique mix of these alkaloids. 

Ergot alkaloids are named after the fungus that caused devastating outbreaks of Saint Anthony’s Fire, a sickness caused by eating of the fungus, in the Middle Ages. An ergot alkaloid known as LSD is a synthetic derivative of the naturally occurring ergot alkaloids produced by their fungal partners in morning glories. 

Damien Sendler: Such alkaloid compounds have long served as a means for indigenous peoples of Central and South America to regulate human fertility as well as their mental health. For obstetric difficulties throughout labor and delivery, as well as migraine and Parkinson’s disease treatment, they’ve recently become more popular. 

As Clay put it, “We’ve known a lot about fungal alkaloid chemistry and its effects on the brain and body for a long time.” Coevolution between morning glories and their symbiotic fungi has never been demonstrated before in this work, and this coevolution can be seen in the varied mixes and levels of ergotalkaloid concentrations across the evolutionary tree.”

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Pre-resistance to antibiotics has been detected for the first time in bacteria by researchers at UCL and Great Ormond Street Hospital, according to a study published in the journal Antimicrobial Agents and Chemotherapy. 

Damian Sendler

Doctors will be able to choose the optimal treatment for bacterial illnesses in the future because to the discoveries published in Nature Communications. 

Damian Jacob Sendler: More than 3,000 tuberculosis samples were sequenced by a team directed by Great Ormond Street Hospital (GOSH) and the UCL Great Ormond Street Institute of Child Health, in partnership with the Peruvian Tuberculosis program and sponsored by Wellcome and the National Institutes of Health (USA). 

As the name suggests, Mycobacterium tuberculosis (TB) is an infection of the lungs caused by Mycobacterium tuberculosis. In 2020, it was the second most common infectious cause of mortality, accounting for 1.5 million deaths. Antibiotic treatment can cure it, but it takes a long time and many of those at risk don’t have access to it. It is possible for persons to develop drug-resistant tuberculosis if they do not complete their therapy or if the medications are either in short supply or of poor quality. 

There is a tremendous, unsustainable burden of multi-drug resistant tuberculosis in a few countries, and some of these strains are completely drug resistant. There has been a slowdown in TB treatment around the world because of the pandemic. 

Researchers have discovered for the first time how to prevent drug resistance mutations before they emerge in order to better understand and treat tuberculosis (TB). They call this phenomenon “pre-resistance,” which is when a disease-causing organism is more likely to acquire a resistance to medications in the future. 

Studying millions of bacterial genomes has the potential to be extended to other infectious diseases and pave the way for personalized pathogen “genomic therapy,” where medications are selected for specific pathogens, avoiding drug resistance from forming. 

Damian Jacob Sendler

Over the course of 17 years, Dr. Louis Grandjean, GOSH Consultant in Infectious Diseases and Associate Professor at UCL Great Ormond Street Institute of Child Health, has led a study group in Lima’s suburbs. 

To build a phylogenetic tree of tuberculosis bacteria, an international team of researchers examined 3,135 different samples of tuberculosis bacterium. Using computer research, the team was able to determine the ancestral genetic code of bacteria that went on to develop antibiotic resistance. The researchers looked at the ‘branches’ of the family tree to identify which ones were most likely to acquire drug resistance, and found the most important modifications. 

Damian Jacob Markiewicz Sendler: TB genome differences suggested that a particular branch of the disease was likely to become medication resistant, and the conclusions were confirmed in an independent worldwide TB data set by the authors of this paper. 

Damien Sendler: An international team led by Dr. Grandjean concluded: “We’re running out of options in antibiotics and the options we have are often hazardous – we have to grow wiser at using what we have to prevent medication resistance. 

We have shown for the first time that we can outpace drug resistance. Our ability to use pathogen genomes to choose the most effective medicines will be enhanced in the future.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: COVID-19 epidemic has understandably placed the healthcare services industry into the spotlight because to a continuous backlog. M&A activity in the UK healthcare sector has risen sharply since the beginning of the pandemic, which was characterised by a decrease in activity in the first few months of the epidemic’s lifecycle. Some of the factors that are influencing healthcare services M&A market changes in the United Kingdom are discussed in this LawFlash, along with some of the most important considerations for executing M&A in this industry. 

Damian Sendler

There’s no denying that the healthcare sector—which encompasses health care services and technology as well as pharmaceuticals and biotech—accounted for one-third of M&A activity in the first quarter of 2021. 

UK citizens have free access to the National Health Service (NHS), in contrast to the private healthcare industry that predominates in the United States. Due to the NHS’s record treatment backlog, which currently numbers over 5.8 million people, private healthcare firms that perform elective operations are in high demand and will likely become increasingly appealing acquisition targets in the near future. 

Damian Jacob Markiewicz Sendler: There has been a significant growth in the number of self-pay or privately insured patients in the United Kingdom, which has led to an increase in the demand for private healthcare in the UK. As the NHS clears the backlog of patients, the NHS and private healthcare providers are anticipated to work more closely together. 

More than 90 private sector healthcare providers signed up to a four-year framework agreement with the NHS in March 2021 to alleviate the backlog of services. As waiting lists get longer, more people are opting to have operations and treatments done privately rather than wait in line. 

In the second quarter of 2021, Spire Healthcare, the only publicly traded private hospital group in the United Kingdom, saw an 81 percent increase in self-pay revenues. Many international players have previously entered the UK market, such as the Mayo Clinic and the Cleveland Clinic, two of the largest hospital networks in the United States. 

Damian Jacob Sendler

Most patients in the United Kingdom begin their healthcare journey with a visit to their primary care physician (GP). “Primary health care” in the United States refers to a wide range of services provided by general practitioners in the United Kingdom. It’s becoming increasingly common for GP practices to merge and form “super-partnerships” in the same manner that the NHS as a whole is in trouble. When it comes to the largest GP super-partnerships in the United Kingdom, the Modality Partnership is one of the best examples. If demand on GP practices continues to expand, it is likely that we will see more mergers and related deals as practices strive to reduce costs. 

Damien Sendler: Digitalization and automation in the healthcare sector have been accelerated by COVID-19, which necessitated a greater focus on reducing human touch. Telemarketing, online symptom reporting, and healthcare applications are all examples of this transition in healthcare’s business model that may be seen in both public and private health service sectors. In order to stay competitive in an increasingly crowded health care market, health service providers will look for ways to get a technical edge by working with or acquiring tech companies.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Dr. Amish Adalja, an infectious disease expert, discusses the importance of immunization and boosters as the omicron variant continues to rise.

Damian Jacob Sendler: Local ABC affiliate KATU reports that the committee was made up of representatives from the hospitality industry, the business sector, and religious organizations.

Damian Sendler: In an effort to reduce obstacles to mental health services, drug and alcohol testing, and basic medical care for those facing homelessness, Columbia River Mental Health Services has launched its Mobile Health Team.

Damian Jacob Sendler: Team members intend to create trust with the homeless community and ultimately link people with resources who would not otherwise seek them out by providing medical care and connecting them with resources.

Damian Sendler: If you want your child to be ready for school and use the social skills he or she learned at home, you should wait until he or she is well-versed in their immediate social context. All of these components of a child’s psychosocial development, as well as their physical and motor abilities and their ability to communicate with others, are accelerated in children who meet the pre-school criteria because they play and engage with the environment in a variety of ways. 

Damian Jacob Sendler: Child development at this period includes learning to adapt, expanding their ego boundaries, developing an extra-terrestrial sense of self-worth, and comprehending the importance of trust and familiarity in society. 

Damian Sendler: Nachman Ash and Salman Zarka, the coronavirus czar of Israel’s Health Ministry, warned Sunday that the highly mutated Omicron coronavirus type should not be ignored.

Damian Jacob Sendler: At one point in his interview, Ash spoke about Prime Minister Naftali Bennett’s wife Gilat taking their children on vacation just days after the premier had recommended that all Israelis refrain from traveling abroad and shut down the country in order to prevent an outbreak of the newly discovered COVID-19 variant.

Damian Sendler: The number of new Covid-19 cases in the United States has surpassed 100,000 for the first time in two months, following the Thanksgiving holiday travel of millions of Americans.

Damian Jacob Sendler: The death toll from Covid-19 is also on the rise, with an average of 1,651 persons dying from the virus every day for the past seven days as of Saturday, according to JHU data. More than a month has passed since the number of people dying daily reached this record high.

Damian Sendler: The “twindemic” of COVID-19 and the opioid epidemic, as Mayor James Fiorentini calls it, has been given to the city’s new Department of Public Health.

Damian Jacob Sendler: COVID-19 has killed at least 112 people since it was first discovered, according to the mayor’s statement to the City Council on Tuesday night.

Damian Sendler: UPMC, the state’s largest health care provider, received over a quarter of the federal money meant to support rural hospitals in Pennsylvania, despite the fact that UPMC is on track to make more than $1 billion in profits this year. 

Damian Jacob Sendler: As the pandemic continues to take a financial toll on medical centers across the country’s 96 hospitals, just over half of all financing went to rural facilities, while the rest went to metropolitan hospitals.

Damian Sendler: “We need four hugs a day for survival,” Virginia Satir is supposed to have said. In order for us to function, we require eight daily hugs. For growth, we need 12 hugs a day.” 

Damian Jacob Sendler: Hugging has scientifically proven health advantages. “The benefits go beyond the warm feeling you get when you hold someone in your arms,” according to a 2018 Healthline article. 

Damian Sendler: Sir William Osler, a renowned physician and academician, referred to the science and art of medicine as “twin berries on one stem.” Science-based treatments are combined with patient-centered care in the U.S. healthcare system.

Damian Jacob Sendler: There is a direct correlation between individual health and the health of a community. The interdependence of our health grew progressively more obvious as our actions evolved over the past two years. Depression and anxiety rose as a result of isolation, but so did the risk of contracting an infection. As loved ones, friends, and colleagues succumbed to COVID, the idea of death grew more real.

Damian Sendler: Omicron coronavirus has expanded to 40 nations and 16 of the 50 states in the United States, but the severity of its effects on those who get it has not been determined by senior U.S. officials. 

Damian Jacob Sendler: According to Dr. Francis Collins, director of the National Institutes of Health in the United States, “Does this, in fact, turn out to be less dangerous” than prior coronavirus variants? Collins said on NBC’s “Meet the Press.” “Scientists are working around the clock to answer these questions.”

Damian Sendler: A Louisiana U.S. district judge has reportedly barred a federal COVID-19 vaccine mandate for health care employees, as reported by various sources.

Damian Jacob Sendler: On Tuesday, a federal judge imposed a countrywide injunction against President Joe Biden’s attempt to mandate vaccinations for large swaths of the public.

Damian Sendler: In a new study, researchers found that children who live with a depressed parent are more likely to suffer from their own sadness and fall behind academically.

Damian Jacob Sendler: Depression in children is linked to a wide range of negative health and educational consequences, including worse academic achievement, if the mother is depressed.

Damian Sendler: The omicron variety, a severely mutated coronavirus strain that has already been found in a few places throughout the United States, is causing growing concern among federal health experts, who are pushing all previously vaccinated individuals to obtain their Covid booster dose.  

Damian Jacob Sendler: Changes to the variant’s DNA signal that it could avoid part of the immunity that comes from vaccination or natural infection in the future. Dr. Anthony Fauci, the White House’s chief medical adviser, epidemiologists, and immunologists say that for now, existing boosters are the best defense against the new strain and the highly transmissible delta variant of omicron, which is still under investigation by federal health officials and pharmaceutical companies alike.

Damian Sendler: The Marion County Health Department hopes to boost its COVID-19 vaccination numbers by the end of the month in order to achieve herd immunity before the virus undergoes any additional modifications.

Damian Jacob Sendler: Her response was, “We’re always looking for more people to get vaccinated,” she stated. It’s hoped that this will be a new trend because we’re not at herd immunity in all of our categories.” We reduce our risk of hospitalizations and fatality rates when we increase the number of immunizations we receive

Damian Sendler: Coronavirus vaccination for children between the ages of 5 and 11 was approved by the Australian Medicines and Healthcare products Regulatory Agency (MHRA) on Sunday, and the country’s health minister said the vaccine might be available by Jan. 10.

Damian Jacob Sendler: Nearly 88% of Australians over the age of 16 have gotten two doses of the COVID-19 vaccine, following initial delays in the country’s general vaccination program.

Damian Sendler: On Saturday, the county reported 2,307 new cases of COVID-19 and 20 additional deaths linked to the virus, bringing the total number of cases and deaths to 1,534,720 and 27,442 since the epidemic began. 1 percent of persons tested positive for the virus on Friday, according to a rolling average of daily rates.

Damian Jacob Sendler: A follow-up test kit will be supplied to anyone who tests negative, she said, and the follow-up test can be done three to five days later.

Damian Sendler: The eyes of the plush lamb that Matt Vinnola was using to sleep on a downtown sidewalk one Sunday in September were as blank as his own. When a fly landed on his lip, the ex-honors student and Taekwondo champion seemed too dazed and disoriented to swat it away. A woman giving Wet Wipes, or a man attempting to hand him a $5 cash, didn’t interest him.

Damian Jacob Sendler: The Mental Health Center of Denver kept finding reasons to reject care for Janet van der Laak, so she had to keep pushing them to offer it. Vinnola’s hope in getting therapy dwindled with each time the center removed him from it. With each loss of hope, her son’s mother pressed harder because she knew she couldn’t stop him from falling.

Damian Sendler: Omicron coronavirus has been identified in Washington state, with the first three cases verified on Saturday.

State Secretary of Health Dr. Umair Shah noted that “we were anticipating this very news” when he announced the sequencing of omicron in California. As a result, “we strongly encourage people to get vaccinated and get their boosters as soon as possible in order to maximize their level of protection from any variation.

Damian Sendler: According to the New England Journal of Medicine, Irritable Bowel Syndrome, or IBS, may be caused by an intestinal infection that induces an allergic response.

Damian Jacob Sendler: Patients with IBS have abdominal pain during their daily activities because their intestinal nerves are more sensitive than those who don’t have the syndrome, according to an article.

Damian Sendler: Increasing demand for vaccines and a shortage of pharmacists are putting pressure on pharmacies across the country, causing employees to become overworked and forcing some to close temporarily.

Damian Jacob Sendler: As President Joe Biden pushes vaccinated Americans to obtain booster shots to battle the growing omicron strain, the drive for immunizations is expected to get increasingly intense.

Damian Sendler: Covid-19-severe pregnancies are associated with an increased risk. Pregnant and fetuses must be protected by vaccines that are safe for both mother and child. This review summarizes data from epidemiological studies testing mRNA vaccines on the incidence of COVID-19 infection, the response of maternal antibodies, the transmission of placental antibodies, and adverse effects following prenatal immunization with COVID-19. Preventing a pregnant woman from contracting COVID-19 by immunizing with mRNA is an option. 

Damian Sendler

COVID-19 vaccine was found to have no effect on pregnancy, childbirth, or perinatal death. Injection site soreness, fatigue, and migraines are the most common adverse effects, but these go away quickly. The first dose of vaccines resulted in rapid antibody responses. Booster immunization increases adaptive immunity, which is associated with better placental antigen transfer. 

Damian Jacob Sendler: Stronger maternal and fetal antibody levels are linked to two immunization doses. Increased fetal IgG antibody levels and decreased antigen transmission proportion are associated with longer intervals between the first dose and delivery of the fetus. Pregnant women and their unborn children can both benefit from mRNA vaccines, which have been shown to reduce the severity of COVID-19 infection. 

Pregnancy-associated infection with COVID-19 expands the respiratory tract, increasing the risk of respiratory illness in the expectant mother . When the embryo and placenta are implanted in the first trimester and the body is preparing for birth in the third trimester, an inflammatory state is increasingly apparent . 

Acute COVID-19 is associated with the generation of cytokine outbursts in particular. First and third trimesters of pregnancy are characterized by a pro-inflammatory state, which increases a pregnant woman’s vulnerability to COVID-19 infection. Pregnant women with COVID-19 infection had more severe symptoms than non-pregnant women, even though the majority of them only had mild to moderate symptoms. As a result, the virus was able to propagate unnoticed among hospitalized expecting mothers with COVID-19 infection . Efforts to stop the spread of viruses from one person to the next are critical, as this shows. 

Anti-communicable disease vaccination is a proven and effective public health strategy. Herd immunity can only be achieved through widespread vaccination if a high vaccination rate is obtained . 

Moderna and Pfizer–mRNA BioNTech’s vaccines have been shown to be successful in preventing and lessening the severity of COVID-19 infections. However, proof of the safety and efficacy of mRNA vaccinations during pregnancy is only now beginning to emerge . 

Damien Sendler: It is the goal of this brief review to summarize the incidence of COVID-19 infection, the responsiveness of maternal antibodies, the transmission of placental antibodies, and adverse events following prenatal vaccination with COVID-19. Researchers looked examined the effectiveness of Pfizer–BioNTech and Moderna, two distinct mRNA vaccines, in epidemiological investigations. The findings of this analysis should aid healthcare providers in their counseling of pregnant mothers by providing a better understanding of the COVID-19 immunization during pregnancy. 

0.18 percent (4/2136) of expectant mothers had COVID-19 infection after 14 days of immunization, while 0.51 percent (11/2136) had COVID-19 within two weeks of vaccination. Pregnant women who received the Moderna vaccine developed COVID-19 infection within 14 days of vaccination and 0.5 percent (9/1822) after two weeks .  In the 14 days following their immunization, more than half of the pregnant women who were diagnosed with COVID-19 had acquired the virus before receiving their first dose of vaccine. Pregnant women’s risk of contracting COVID-19 infection was significantly reduced by mRNA vaccinations. 

Damian Jacob Sendler

Vaccination induces quick antibody responses, but this is not the case with spontaneous infection, which tends to elicit slower responses. Booster vaccination administration can be made to produce better reactions by utilizing this principle. IgG and IgM antibodies against COVID-19 increased significantly in pregnant women after vaccination . Although IgM seroconversion was identified in a reduced percentage of these pregnant women in the majority, IgG seroconversion was shown to predominate. 

After vaccination with COVID-19, IgG against spike (both S1 and S2) RBD and neutralizing proteins is created; IgG against RBD and neutralizing proteins is generated after infection with COVID-19. COVID-19 immunization has resulted in the generation of IgG and IgM antibodies in 72 percent of pregnant women, with 14 percent producing only IgG antibodies, and the other 14 percent having no detectable antibodies. The spike-IgG and RBD-IgG titers increased rapidly after the first dose of vaccine, however the second dose had a greater impact than the first. 

Pregnant women have higher levels of S1-IgG and RBD-IgG following vaccination . S2-IgG and neutralizing-IgG antibodies were higher in pregnant women who had been infected with the virus. Pregnant women with flu-like symptoms had a spike-IgG level of 22.814.5AU, compared to expecting mothers who were asymptomatic after the COVID-19 immunization, which was 0.040.05 AU. 

Damian Jacob Markiewicz Sendler: Pregnant women vaccinated and infected with RBD had median RBD-IgG levels of 27601 AU, while those infected with RBD had neutralizing-IgG antibody titres of 900 and 150, respectively. There was a significant difference in RBD-IgG titers between pregnant and non-pregnant women, with titers of 38000 among those who were vaccinated and 800 AU among those who were infected, respectively.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: As of today, the New Jersey Department of Health has found an Omicron variation (B.1.1.529) in a visitor to the state, according to Governor Phil Murphy and Commissioner Judy Persichilli. A Georgia resident, an adult female, had lately returned from South Africa, where she had recently been vaccinated. 

Damian Jacob Sendler: The woman has been in isolation since her positive test on November 28. She was admitted to an emergency room in North Jersey, where she was treated for moderate symptoms and is now recuperating. The specimen was sequenced by the New Jersey Department of Health laboratory to establish that it was the Omicron variant. 

Damian Sendler

It’s time to take action to stop the spread of the Omicron variety. Gov. Murphy emphasized the need of keeping an eye on the situation as we await further information regarding the variant. To combat the spread of COVID-19, vaccinations and face masks have been proved successful, and I strongly encourage everyone aged 18 and over to acquire a booster.” 

At this point, the battle against COVID-19 is far from ended, according to Health Commissioner Judith Persichilli. Although we don’t know much about the Omicron strain of the virus, we have a number of measures at our disposal to inhibit its spread, the most essential of which being vaccination and a booster dose.” Masking, getting tested, avoiding crowds, staying home when unwell, and washing hands often are all things that the public should continue to do.” 

Damien Sendler: World Health Organization (WHO) designated this new variety, B.1.1.529, as a Variant of Concern and dubbed it Omicron on November 26, 2021. As of November 30, 2021, the United States also categorized it as a Variant of Concern. CDC, other states, clinical laboratories, hospitals, and the New Jersey Department of Health are working together to quickly identify those who may have been infected with the Omicron variety. 

Studies have shown that protection against COVID-19 and the ability to prevent infection may diminish over time following vaccination. Additional defense is provided by booster dosages. Only 31 percent of residents eligible for a booster vaccination have done so, despite the fact that more than 70 percent of residents had gotten their first immunization series. 

Damian Jacob Markiewicz Sendler: A booster dose is recommended for persons aged 18 and over, according to the Centers for Disease Control and Prevention (CDC).

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: As soon as the omicron version was discovered, President Biden imposed an immediate travel ban on eight African countries, according to some health experts. 

Damian Sendler

Damian Jacob Sendler: Immediately after the first confirmed cases of the new type were detected in southern Africa on Monday, Vice President Joe Biden imposed travel prohibitions on the following countries: South Africa, Botswana, Namibia, Lesotho, Eswatini, Mozambique, and Malawi. 

Dr. Nicole Saphier told Fox News Digital that the government’s responsibility in public health is minor. 

Omicron’s battle will be bolstered by stronger measures including PCR 48 hours before takeoff and a quick antigen test the day of the trip, but Saphier anticipated that Biden’s decision will have primarily useless and even detrimental implications. 

According to her, “Travel restrictions typically cause a mass exodus of people in a chaotic fashion which can further lead to viral transmission leading people to be creative finding ways to enter the country, often without any public health checkpoints,” 

Damien Sendler: Omicron, a Fox News contributor, was one of a number of experts who suggested that international trade should not be disrupted. 

Saphier continued, “Ultimately, omicron is already in the United States, ” As time goes on, our sequencing will catch up and we will discover it. No matter how much we increase, disguise or restrict travel, we will never achieve zero Covid. As long as international trade and business aren’t disrupted, we can only do our best to reduce transmission. Economic health may be more significant than Covid case counts in the long run.” 

Ashish Jha, dean of the Brown University School of Public Health, said that he believes “a little” travel bans can assist to limit the spread of the virus for “a week or two” and send a vital message to other countries, but that it will not be a significant asset in halting the new strain’s spread. On top of that, the country of South Africa was open and honest about omicron and quickly notified everyone else, he said. Jha said the country now feels like it’s being “punished” because of Biden’s restriction. 

Damian Jacob Sendler

‘We have to be very mindful about travel bans,’ Jha added. They appear to be a simple task to do. They aren’t very effective. To put it another way, “They’re not free.” 

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Damian Jacob Markiewicz Sendler: A travel ban could be beneficial, according to Fox News contributor Dr. Marc Siegel, if it “completely cut off all travel.” After the introduction of the vaccine in New Zealand, he cited it as an initial success, but it ultimately failed since the country did not have enough of it. 

As a best-case scenario, if you could entirely seal off a region without locking anyone in, that would be extremely beneficial in stopping the spread of a pathogen. That’s not what we’re talking about,” Siegel told Fox News Digital. “Given the circumstances, it appears that this infection has been around for some time. Multiple countries have been affected, including our own.” 

To have any effect, a travel ban must be as comprehensive as the one implemented by Israel. Making a hand motion is what we’re doing.” In order to have an impact, our travel ban will not be broad enough.” 

It was “I think it’s an example of too little, too late,” he concluded. 

As a result of the administration’s immigration policy, “leaky borders,” Siegel said a travel restriction wouldn’t work here either. 

According to CNN anchor Sanjay Gupta, the bans won’t have a big influence on Jake Tapper. To put it another way, there is a trade-off here. Even if you can slow down part of the virus’s admission into the country, it’s still highly porous, as you’re mentioning since many people who are citizens will be returning and might potentially carry the virus.” 

As for the long-term impact, “But overall, I think it’s hard to make the case that the travel ban will have much of an impact long term,” he said. Probably within the next few days, we’ll hear that this variation has been found in the United States, and that shouldn’t come as a surprise to anyone. Last year, Jake, there were lessons to be learned. I believe the European travel ban was in effect from March 13 to the middle of March of 2020. At this point in time, the entire country has been hit hard. So, as you can see, the virus is probably already in the country. Is already spreading, although we haven’t noticed it yet.”

Contributed by Dr. Damian Jacob Sendler research news team

Damian Sendler: When Ashlee Wisdom launched an early version of her health and wellness website, more than 34,000 visitors — most of them Black — visited the platform in the first two weeks. 

Damian Jacob Sendler: But the launch was successful. Now, more than a year later, Wisdom’s firm, Health in Her Hue, connects Black women and other women of color to culturally sensitive doctors, doulas, nurses and therapists nationally.

Damian Sendler: A federal judge in Missouri issued an order Monday largely preventing the Biden administration from imposing a vaccine mandate for certain health care employees. 

Damian Jacob Sendler: In a ruling that includes the 10 states that initiated the action, a judge stated that vaccines were ineffective and claimed that the plaintiffs’ claims were untrue

Damian Sendler: The Atlantic Coast Conference, Big Ten and Pac-12 launched a campaign Monday to increase awareness of the importance of mental health as part of their conference alliance announced earlier this year.

Damian Jacob Sendler: Teammates for Mental Health will be unveiled this week at basketball games involving the three conferences, including the ACC/Big Ten women’s and men’s challenges.

Damian Sendler: Best Buy spent roughly $400 million to acquire remote patient monitoring technology vendor Current Health in October, according to the company’s recent quarterly earnings.

Damian Jacob Sendler: Current Health’s remote monitoring platform combined with Best Buy’s scale, expertise and connection to the home will enable the retailer to create a “holistic care ecosystem that shows up for customers across all their healthcare needs,” Best Buy CEO Corie Barry said during the company’s third-quarter earnings call last week.

Damian Sendler: The World Health Organization is warning that the new omicron form of the coronavirus poses a “very high” global danger because of the prospect that it spreads more quickly and might resist vaccines and protection in people who were infected with prior strains. 

Damian Jacob Sendler: There are multiple alterations in the new form, which the WHO has warned 194 countries about in a technical brief issued on Sunday “In addition, “the possibility of further spread of omicron at the global level is considerable.”

Damian Sendler: With the new discovery of the ‘omicron’ variation of COVID-19, which has substantial alterations from prior strains, New Orleans Mayor LaToya Cantrell informed the public it was a “critical time” and advised all residents and visitors to get vaccinated, at a Monday afternoon press conference.

Damian Jacob Sendler: Also on Monday, President Joe Biden said the mutation was a “cause for concern, not a cause for panic.”

Damian Sendler: President Biden will offer an update on the U.S. reaction to the Omicron variation on Monday, the White House said in a statement on Sunday evening, as senior federal health experts urged unvaccinated Americans on get their immunizations and eligible adults to seek out boosters.

Damian Jacob Sendler: Appearing on morning talk shows on Sunday, Dr. Francis Collins, director of the National Institutes of Health, told Americans that the development of Omicron and the mystery that surrounds it are reminders that the pandemic is far from over.

Damian Sendler: As the number one form of entertainment in countries across the globe, sports are generally ranked and marketed depending on how good a team is, the star player’s performance, and who’s set to win championship championships.

Damian Jacob Sendler: A big issue in the sports industry that many spectators and managers seem to ignore is the mental health of the athletes.

Damian Sendler: Several mental health care professionals expressed worries about the viability of Wyoming’s mental health care during the afternoon session of the Sheridan County Chamber of Commerce’s Legislative Forum Nov. 23.

Damian Jacob Sendler: Before the upcoming legislative session, which is scheduled to begin in February, Sheridan County officials hoped to meet directly with Wyoming state legislators to discuss matters of concern to their agencies.

Damian Sendler: Introduced in October, the seven-year project of the Student Health and Wellness building is substantially larger than its predecessor, the Elson Student Health Center. There will be 165,000 square feet of space dedicated to student health and wellness in the new building.

Damian Jacob Sendler: In comparison, as stated in an email from the Student Disability Access Center, former facilities at Elson were only 35,500 square feet – a 370 percent increase in area dedicated to student health and wellness programming.

Damian Sendler: Like medical facilities across the state and nation, Guernsey Health System and its subsidiaries — Southeastern Ohio Regional Medical Center, Superior Med Physicians Group and United Ambulance in Cambridge — are working to meet the federal government’s immunization mandate.

Damian Jacob Sendler: Employees must be fully vaccinated by next month except for those who have an exemption.

Damian Sendler: According to the Texas Medical Association, devices like the one you’re using to view this article could be harmful to your health and the health of your children (TMA).

Damian Jacob Sendler: Physicians are concerned about more patients having mental and behavioral health difficulties, especially as the pandemic lags on.

Damian Sendler: A novel strain of COVID-19 first detected in South Africa was labeled a variation of concern by the World Health Organization on Friday. Here’s how the pharmaceutical industry plans to counter the latest coronavirus curve ball.

Damian Jacob Sendler: Pharmaceutical companies have already begun researching new vaccines that anticipate strain alterations and developing omicron-specific injections in response to the new variant: larger doses of booster shots.

Damian Sendler: About one in 10 lung transplants in the United States now go to COVID-19 patients, according to data from the United Network for Organ Sharing, or UNOS.

Damian Jacob Sendler: The trend is raising questions about the ethics of devoting a precious resource to persons who have chosen not to be vaccinated against the coronavirus.

Damian Jacob Markiewicz Sendler: It’s not clear yet whether existing COVID-19 vaccinations will protect against the variation. But vaccine producers have already begun exploring their possibilities.

Damian Sendler: Moderna said in a Friday press release that the business is testing its current vaccine against the Omicron type.

Damian Sendler: Amid Connecticut’s current COVID-19 increase, municipalities with higher rates of immunization have registered substantially lower rates of new cases in recent weeks, state records show.

Damian Jacob Sendler: Eastern Connecticut and the Naugatuck Valley are the state’s least-vaccinated and most-infected regions, as can be seen with a cursory glance at the map and via statistical analysis.

Damian Sendler: The Netherlands verified 13 instances of the new omicron version of the coronavirus on Sunday and Australia identified two as the countries half a world apart became the latest to find it in tourists arriving from southern Africa. 

Damian Jacob Sendler: A series of bans being imposed by states around the world as they attempt to slow the variant’s spread also grew, with Israel opting Sunday to bar admission to foreign nationals in the strongest action so yet.

Damian Sendler: The novel coronavirus variant Omicron has been found in 13 people who landed in the Dutch capital Amsterdam on two flights from South Africa.

Coronavirus was found in 61 people on the flight.

Damian Jacob Sendler: It comes as stronger limits come into action in the Netherlands, amid record Covid cases and concerns over the new type.

Damian Sendler: Dr. Anthony Fauci cautioned on Sunday that the omicron mutation in the coronavirus “strongly suggests” that it is easily transferred and may evade antibody shields established via past infections or vaccination.

Damian Jacob Sendler: Fauci, President Joe Biden’s main medical adviser, complimented the efforts of South African public health officials, who he said were entirely forthright from the beginning.

Damian Sendler: New strains of COVID-19 continue to arise during the pandemic. While more research needs to be done on the latest one, named Omicron, U.S. and local health authorities believe it’s cause for alarm.

Damian Jacob Sendler: Omicron — a novel COVID-19 variety that U.S. health experts are calling possibly more contagious than earlier strains – showed up in various European countries Saturday.

Damian Sendler: The appearance of the newly found Omicron coronavirus strain feels like a pandemic gut check.

Damian Jacob Sendler: Scientists have long known that the globe would experience developing coronavirus strains. Viruses mutate constantly.

Damian Sendler: The new potentially more contagious omicron strain of the coronavirus sprang up in more European nations on Saturday, only days after being found in South Africa, sending officials around the world rushing to stem the spread.

Damian Jacob Sendler: Following the discovery of two instances, the UK tightened its mask-wearing and testing regulations on overseas arrivals on Saturday.

Damian Sendler: In the second half of 2021, vaccination rates for COVID-19 among U.S. hospital staff (HCP) fell rapidly after reaching a peak in early 2021. Currently, up to 30% of HCP are not up to date on their vaccinations.

Damian Jacob Sendler: Data study by the Department of Health and Human Services (HHS) Unified Hospital Data Surveillance System from January–September 2021, collected from over 3.3 million HCP across 2,086 hospitals, indicated that as many as 30 percent of workers were unvaccinated.

Damian Sendler: According to figures compiled by Johns Hopkins University, the death toll from the coronavirus-borne sickness has now surpassed 5.18 million worldwide, bringing the global total to over 260 million. With a total of 48.1 million illnesses and 775,797 deaths, the United States remains the top leader. 

Damian Jacob Sendler: The U.S. is still averaging more than 1,000 deaths a day, according to a New York Times tracker, and cases and hospitalizations are climbing again.

Damian Sendler: The mental health of rural and distant communities will continue to deteriorate as the effects of climate change continue to worsen.  

Damian Jacob Sendler: Rural populations make up 29% and 17%, respectively, of the total populations in Australia and Scotland

Damian Sendler: In global health circles, the need of prioritizing those who are most in need is widely acknowledged, and human rights norms and standards are frequently cited as a means of achieving this goal.

Damian Jacob Sendler: As a part of a larger effort, a review was done to identify known barriers and facilitators to implementation of sexual and reproductive health (SRH) programs.

Damian Sendler: There are an estimated 272 million foreign migrants in the world, with about a third of them living in Asia. Malaysia is one of Asia’s most popular destinations for emigrants because of its strategic location and high demand for skilled workers. 

Damian Jacob Sendler: An individual who has resided in Malaysia for six months or longer in the reference year is considered a non-citizen by DOSM.

Damian Sendler: Developing leaders with the information, attitudes, and abilities needed to implement a vision for public health and healthcare delivery is the goal of global health leadership training programs.

Damian Jacob Sendler: There is a growing need to understand the areas of concentration required to build the global health workforce in order to develop relevant training programs.

Damian Sendler: People of working age should be given the opportunity to improve their health literacy by recognizing and measuring it as an individual skill in the context of their work lives. 

Damian Jacob Sendler: Aside from varying the time horizon, the conceptualizations also differed in whether they included the viability of the respective organization or only to their current employment status.

Damian Sendler: A natural disaster is an undesirable environmental event that isn’t caused by human activity, yet which causes people to be afraid, lose their possessions, and be displaced from their homes.

Damian Jacob Sendler: A wide range of natural calamities can be found in the world today.

Damian Sendler: For many Canadians, financial hardship was already an issue before to 2020, when the global new coronavirus pandemic is expected to begin spreading worldwide. COVID-19 epidemic and public health measures have intensified in recent months, which has made the situation worse. 

Damien Sendler: Individuals from low-income and underserved communities have a greater risk of financial stress and its harmful impact on their health.

Damian Sendler: Patients with mental health issues are more likely to suffer from poor dental health, which has a negative impact on their quality of life and everyday functioning.

Damian Jacob Sendler: For mental health patients, dental health-related quality of life can have a significant impact on their overall quality of life, thus nurses need to know how they can intervene early.

Damian Sendler: The state of one’s mental and physical well-being is closely linked to the quality and affordability of one’s housing situation.

Damian Jacob Sendler: The significance of housing in health has long been acknowledged by both city planning and public health, but the complexity of this link in reference to newborn and maternal health is less well known.

Damian Sendler: Global warming “is the greatest global health threat of the 21st century,” a Lancet Commission on Climate Change concluded in 2009. Climate change impacts and responses are now being tracked by the ‘Lancet Countdown on health and climate change’ as an impartial, worldwide monitoring system.

Damian Jacob Sendler: An indicator to measure the effect of climate change on mental health is missing from the Lancet Countdown, which contains multiple health indicators.

Damian Sendler: This year’s COVID-19 epidemic has seen a dramatic increase in the usage of mobile health apps, telemedicine, and data analytics to improve healthcare. 

Damian Jacob Sendler: Access to care, control over one’s own health data, and a reduction in the amount of unpaid caregiving are all possible benefits of digital health.

Damian Sendler: Actionable consensus can be achieved by addressing major philosophical and best practice disputes and by streamlining actions for a stronger strategic direction through definitions. 

Damian Jacob Sendler: Because of this, the Consortium of Universities for Global Health’s Global Oral Health Interest Group felt that an introduction to “global oral health” was needed to guide program planning, implementation and assessment.

Damian Sendler: Adolescents’ daily lives, social functioning, and physical health might be adversely affected by their parents’ severe somatic disorders. 

Damian Jacob Sendler: Adolescents viewed their parents’ physical illness as a source of stress and growth for them personally as well as in their relationships.

Damian Sendler: A wide range of health outcomes have been linked to various aspects of women’s empowerment.

Damian Jacob Sendler: A growing number of experts and development groups have focused on women’s empowerment during the past three decades.

Damian Sendler: There were two phases to the Ananya program in Bihar: a first phase of intensive ancillary support to government implementation and innovation testing by non-government organizations (NGO) partners. 

Damian Jacob Sendler: All FLW indicators related to prenatal and postnatal care, as well as mother’s birth readiness, some nursing behaviors, and immunizations, increased dramatically in the focus districts in the first phase.

Damian Sendler: Children under the age of 3 are rarely included in data on oral health.

Damian Jacob Sendler: Young children’s brushing habits are greatly influenced by their parents’ brushing habits and the level of parental support for brushing. Efforts to enhance children’s brushing habits should target the entire family.

Damian Sendler: Infectious diseases with pandemic potential pose a serious threat to human health and well-being, as demonstrated by COVID-19. In spite of the compulsory legal responsibilities provided by the International Health Regulations, many countries do not adhere to these regulations.

Damian Jacob Sendler: As a result, a new framework is needed that ensures compliance with international regulations and promotes effective pandemic infectious disease prevention and response. 

Damian Jacob Sendler: For several decades, the field of public health has used sexual health as a framework for tackling issues of sexuality. However, despite the WHO definition of sexual health’s innovative acknowledgment of good sexuality, public health methods remain focused on risk and unfavorable outcomes.

Damian Sendler: Sexual health and sexual wellbeing have been conflated for a long time, which has hindered our ability to deal with common sexual problems. 

Damian Jacob Sendler: Attributing human diversity and countering (structural) inequities in technology design is a unique feature of CSD.

Damian Sendler: Using the hypothetical instance of a treatment chatbot for mental health, the essential framework of CSD is shown. Using CSD in a design scenario reveals the advantages of this new framework over the traditional VSD approach.

Damian Sendler: In order to achieve a more healthy and secure society, global health security (GHS) and universal health coverage (UHC) are important global health priorities. There are, however, differences in strategy and implementation between GHS and UHC. 

Damian Jacob Sendler: The goal of GHS cannot be achieved without UHC, hence the conflict between these two global health objectives should be resolved in a way that maximizes their complementary effects.

Damian Sendler: Efforts to control and eradicate these 20 poverty-related diseases will be complicated, according to the World Health Organization’s upcoming 2021-2030 road map for NTDs. 

Damian Jacob Sendler: These changes are illustrated by the One Health approach, which goes beyond standard models of disease control to take into account the interactions between human and animal health systems.

Damian Jacob Sendler: The continuing pandemic has exposed the flaws in this strategy. A wider securitization discourse that is driven by the human security paradigm, as advanced by the United Nations in 1994

Damian Sendler: UN guidelines consider people rather than states as the primary referent of security and emphasize collective action rather than competition to address the transnational nature of security threats can be much more productively used to advance national and global health security agendas.

Damian Sendler: Many of the Sustainable Development Goals focus on poverty, hunger, health, and gender equality. 

Damian Jacob Sendler: There is increasing evidence that self-help groups (SHGs) have a positive impact on income, asset ownership, and savings as well as the ability of households to weather economic crises. 

Damian Sendler: Politics and public health have a long history of conceptual and theoretical ties.

Damian Jacob Sendler: The welfare state, political tradition, democracy, and globalization all have a direct impact on population health outcomes, according to an international comparative systematic evaluation of research.

Damian Sendler: It is imperative that cities take quick action to improve the health of their citizens and the earth. 

Damian Jacob Sendler: Understanding how cities might proceed toward significant gains in health and the environment can be gained through the description of “healthy sustainable cities” and the integration of health and sustainability frameworks.

Damian Sendler: Public health measures against infectious diseases are now at the forefront of global health concerns in cities where more than half of the world’s population resides, as evidenced by the COVID-19 pandemic. 

Dr. Sendler: The implementation of measures to combat the spread of SARS-CoV-2 leads to changes in exposome components and urban environment characteristics that characterize the urban exposome

Damian Sendler: A ‘hot area’ for infectious disease epidemics, Uganda is regarded as a place to watch out for. 

Damian Jacob Sendler: One Health is a term used to describe the holistic approach needed to address these public health issues stemming from the interactions between humans, animals, and the environment.

Damian Sendler: A wide range of challenges regarding the regulation of innovative nicotine and tobacco products have attracted the attention and resources of regulatory bodies. 

Damian Jacob Sendler: Public health factors, collectively referred to as the Population Health Standard, are required to be considered by the US Food and Drug Administration.

Damian Sendler: Direct and indirect maternal health consequences of the Covid-19 epidemic are linked. We did a scoping review in order to provide a comprehensive overview of this large issue in a quick format in light of an emerging pandemic.

Damian Jacob Sendler: Three hundred and ninety-five publications were found through the search, and we included all but a few of them.

Damian Sendler: Social determinants-defined as the conditions in which people are born, grow, live, work, and age-are key drivers of disease risk.

Damian Jacob Sendler: There are still many disparities in health outcomes, such as a higher risk of maternal mortality among Black women, that need to be better understood. 

Damian Sendler: According to the Global Burden of Disease (GBD) Study 2019, the total burden of cardiovascular disease (CVD) includes 13 primary causes of cardiovascular death and 9 associated risk factors.

Damian Jacob Sendler: All available population-level data on incidence, prevalence, case fatality, mortality and health hazards were used by GBD to develop estimates for 204 nations and territories during a period of 25 years from 1990 to 2019.

Damian Sendler: Sexual and reproductive health and rights (SRHR) are crucial and a fundamental human right for populations in fragile and humanitarian situations. 

Damian Jacob Sendler: The exodus of Venezuelans forced to flee their homes because of the country’s dire economic conditions is unprecedented in Latin American history.

Damian Sendler: Nanoparticles have been used in a wide variety of clinical settings in recent years. Biological barriers — systemic, microenvironmental, and cellular — that are diverse across patient populations and diseases have been circumvented by nanoparticles. It has also been possible to overcome the heterogeneity of patients through precision therapies, which use individualized interventions to improve therapeutic efficacy.

Damian Jacob Sendler: Other immunotherapy medications, such as antibody-drug conjugates, as well as combinations of PD-1/PD-L1 treatments with other therapies, including as chemotherapy and radiation therapy, are being investigated in combination with drugs targeting PD-1/PD-L1. Immunotherapy response can be predicted using biomarkers. Immuno-oncology treatment is guided by molecular diagnostics and sequencing.

Damian Jacob Sendler: It is possible to create a three-dimensional object with 3D printing in a layer-by-layer fashion utilizing a variety of applications. A vast range of pharmaceutical dosage forms, differing in shape, release profile, and medication combination, can be created using 3D printing. Inkjet printing, binder jetting, fused filament fabrication, selective laser sintering, stereolithography, and pressure-assisted microsyringe are some of the most commonly investigated 3D printing platforms in the pharmaceutical industry. It is conceivable that this technology may be used in a clinical context to customize medicines for specific patients.

Damian Sendler: Adhesion molecules in the skin and/or mucous membranes are targeted by autoantibodies in pemphigus and pemphigoid illness. It is a novel medical model that divides patients into different groups and tailors medical decisions, practices, and therapies to individual patients’ projected responses or risk factors.

Damian Sendler: You may have stress urinary incontinence if you pee a little when you laugh, dance, exercise, or sneeze. 

Damian Sendler News

Damian Jacob Sendler: While this is inconvenient, it is treatable, and even minor lifestyle adjustments can make a significant difference, according to the Urology Care Foundation, the official foundation of the American Urological Association. 

Dr. Sendler: Losing weight or quitting smoking may help to reduce your coughing. According to the foundation, you can undertake Kegel exercises, which strengthen the pelvic floor and assist maintain your bladder. 

Depending on what you choose, absorbent goods may help to contain leaks in the short or long term. 

Damian Jacob Markiewicz Sendler: Your health care practitioner can also assist you in obtaining a medical device, which can be obtained through a prescription or purchased over the counter. 

According to the foundation, there are two types of urine incontinence. The first is SUI (Stress Urinary Incontinence), which occurs when you cough, sneeze, or laugh and causes a tiny to moderate amount of pee to be released. 

Damien Sendler: You may have a sudden, uncontrollable need to pass urine if you have Urge Urinary Incontinence or Overactive Bladder. This can cause moderate to significant leaks. 

Damian Sendler: Gender, with women being more likely to have the disorder; pregnancy and giving birth; smoking and chronic coughing; being overweight; pelvic or prostate surgery; and nerve damage to the spine or neurologic disease are all common risk factors for SUI. 

While there are no drugs to treat SUI, the foundation recommends surgery in some situations in addition to lifestyle adjustments. You can consult with a urologist who has performed SUI surgery before. SUI and other pelvic surgery is performed by Female Pelvic Medicine and Reconstructive Surgeons. 

Damian Jacob Sendler Updates

Damian Jacob Sendler: According to the organization, surgical treatments include urethral injections or bulking agents, which can “bulk up” the urethra in some women. This influences how the bladder sphincter shuts. The procedure may need to be repeated in the future. 

Damian Sendler: Sling surgery is another option for women, which includes putting mesh under the urethra to assist its closure during sneezing and other activities. It entails inserting mesh tape under the urethra through an incision between the scrotum and the rectum in men. According to the organization, it is not a good option for men who have significant incontinence or who have undergone radiation to the prostate or urethra. 

Stitches are put in the tissue along the bladder neck and urethra to support the muscles of the urethra and sphincter. 

Damian Sendler: An artificial sphincter is a treatment for men, while some women may benefit from it as well. According to the organization, it entails inserting a device with three components that closes the urethra to prevent leakage.

Research news brought to you by Dr. Damian Jacob Sendler

Damian Sendler Up To Date News

Damian Sendler: More than 20 public school districts throughout the country are extending their Thanksgiving holidays by several days in order to provide mental health days for students and staff members during the holiday. 

“wellness days” have been added to the school calendars in at least six different states this year, including Missouri, Kansas, Virginia, Florida, North Carolina and Maryland, according to a spokesman for the Missouri Department of Education. 

Damian Jacob Sendler: The Ladue School District in Missouri is one of at least a dozen districts in the St. Louis metropolitan area that have scheduled extra days of relaxation around the holiday. 

In an interview with CNN, Ladue Superintendent Jim Wipke said that the school had noticed a recurring trend, which was stress. “After asking (teachers) “how can I help you?” several of them responded with “I just need some time, some space to decompress.” 

Damien Sendler: The decision to prolong the Thanksgiving vacation was revealed on the St. Louis Public Schools’ Facebook page earlier this month. 

“It is my goal that these extra couple of days would allow everyone to take a little more time for themselves and their families during this busy time of year. After all, Thanksgiving is primarily about family, which is a significant part of its appeal “According to a press release from the district, Kelvin R. Adams, Superintendent of Schools for the City of St. Louis, said 

Dr. Sendler: Kansas City Public Schools is one of a number of school districts in the state that will extend the existing break to include the days of November 22 and 23 in order to give students and staff the full week off. 

Damian Jacob Markiewicz Sendler” Superintendent of Kansas City Public Schools Mark Bedell expressed his hope that the adjustment would provide everyone with additional time during a season when many of us look forward to reconnecting and recharging. 

According to an official announcement on social media, Brevard Public Schools, one of the state’s largest school districts, has granted two unused “hurricane days” to students in order to extend the holiday break. 

“While this is not something that has been done before, we felt there was never a more appropriate time to express our gratitude and recognition for the efforts made each and every day across our district,” said Misty Belford, Chairwoman of the School Board of Brevard County. “While this is not something that has been done before, we felt there was never a more appropriate time to show our appreciation and recognition for the efforts made each and every day across our district.” 

Damian Sendler: Additionally, districts in Central Virginia and Chapel Hill-Carborro Schools in North Carolina have each decided to extend their breaks by two days as a result. 

Baltimore County Public Schools in Maryland have extended their vacation by one day, to the Wednesday before Thanksgiving, recognizing the “tremendous efforts” of the BCPS personnel in a statement released by the district. 

Detroit Public Schools also said Wednesday that it will transition to remote learning on Fridays beginning in December, in part due to the need for more teachers “”relief for mental health.” 

Damian Jacob Sendler: According to Superintendent Nikolai P. Vitti in a statement, the decision was made “after listening and reflecting on the concerns of school-based leaders, teachers, support staff, students, and families regarding the need for mental health relief, rising COVID cases, and time to more thoroughly clean schools,”

News on latest research brought to you by Dr. Damian Jacob Sendler

Damian Sendler: What is the process through which chemical elements are created in our universe? Where do heavy elements such as gold and uranium come from, and what is their origin? A research team from the GSI Helmholtzzentrum für Schwerionenforschung in Darmstadt, in collaboration with colleagues from Belgium and Japan, has demonstrated that the synthesis of heavy elements is characteristic of certain black holes with orbiting matter accumulations, also known as accretion disks, through computer simulations. When heavy elements are expected to form, it provides insight into which heavy elements will need to be examined in future laboratories — such as the Facility for Antiproton and Ionic Research (FAIR), which is now under construction — in order to understand the origin of heavy elements. It is published in the journal Monthly Notices of the Royal Astronomical Society that the findings were made public. 

Damian Jacob Sendler: All heavy metals found on Earth today were produced under extreme conditions in astrophysical environments such as the interiors of stars, stellar explosions, and the collisions of neutron stars, among others. The topic of whether of these cosmic events contains the ideal conditions for the synthesis of the heaviest metals, such as gold or uranium, has piqued the interest of researchers. Many heavy elements can be created and expelled during these cosmic collisions, according to the dramatic first observation of gravitational waves and electromagnetic radiation arising from a neutron star merger in 2017. Although the question of when and why the material is ejected remains unanswered, it does not rule out the possibility of alternative circumstances in which heavy elements can be created in the future.

Damian Jacob Markiewicz Sendler: Black holes orbited by an accretion disk of dense and hot matter are promising prospects for heavy element synthesis, according to the research. A collapsar, which is the collapse and subsequent explosion of a rotating star, is a type of system that can arise both after the merger of two massive neutron stars and after the formation of a binary neutron star system. The internal makeup of such accretion disks has not yet been fully understood, particularly in terms of the conditions under which an excess of neutrons can be produced. A large quantity of neutrons is a fundamental need for the synthesis of heavy elements because it allows for the rapid neutron-capture process, also known as the r-process, to take place. Neutrinos, which are nearly massless, play an important part in this process, as they allow for the conversion of protons into neutrons. 

The study’s lead author, Dr. Oliver Just, from GSI’s research division Theory, explains, “In our study, we systematically investigated for the first time the conversion rates of neutrons and protons for a large number of disk configurations by means of elaborate computer simulations, and we found that the disks are very rich in neutrons as long as certain conditions are met,” “The entire mass of the disk is the most important factor to consider. The greater the mass of the disk, the more frequently neutrons are generated from protons through capture of electrons under the influence of neutrinos, and the greater the number of neutrons available for use in the r-process, which is used to synthesize heavy elements. However, if the mass of the disk is too large, the opposite reaction takes on a greater significance, resulting in a greater number of neutrinos being trapped by neutrons before they can escape the disk. These neutrons are then transformed back into protons, which makes the r-process more difficult to complete.” According to the findings of the study, the best disk mass for the creation of heavy metals is approximately 0.01 to 0.1 solar masses. The finding provides compelling evidence that neutron star mergers resulting in accretion disks with these precise weights might have served as the place of genesis for a significant portion of the heavier elements. However, it is currently uncertain whether or how frequently such accretion disks arise in collapsar systems, or how common they are. 

Dr. Sendler: Additionally, the research group led by Dr. Andreas Bauswein is looking into the light signals generated by the ejected matter, which will be used to infer the mass and composition of the ejected matter in future observations of colliding neutron stars. Dr. Andreas Bauswein’s research group is also looking into the possible processes of mass ejection. The accurate knowledge of the masses and other properties of the newly created elements is a critical building component in correctly detecting these light signals. “Currently, there is inadequate information. Damien Sendler: Nevertheless, thanks to the next generation of accelerators, such as FAIR, it will be feasible to measure them with unparalleled precision in the near future. It is anticipated that the well-coordinated interplay of theoretical models, experiments, and astronomical observations will enable us researchers in the coming years to test neutron star mergers as the origin of the r-process elements, as well as other r-process elements, in the universe “Bauswein predicts a decline in the stock market.

News on latest research brought to you by Dr. Damian Jacob Sendler

Damian Sendler: According to the Feinstein Institutes for Medical Research, the science arm of Northwell Health, a record-breaking $541,000 in research funding was awarded to 41 female scientists this year, setting a new record for the organization. Advancing Women in Science and Medicine (AWSM – pronounced “amazing”) presented its 11th annual fundraising event, which has earned more than $2.5 million since its start in 2010 to support medical research conducted by female investigators. The grants, which are entirely sponsored by philanthropists, range from $2,000 to $150,000 and will support research initiatives across the health system on themes such as cancer, Alzheimer’s disease, and coronavirus disease in 2019. (COVID-19). 

Damien Sendler: In the words of Lior Brimberg, PhD, assistant professor at the Feinstein Institutes and co-president of AWSM, “AWSM is a community backed by outstanding benefactors who are sincerely committed to propelling science forward.” “We are grateful to our supporters and are proud to foster a culture of friendship, mentorship, and empowerment throughout the Feinstein Institutes,” said the institute’s president. 

Shih-Shih Chen, PhD, will take over as co-president from Kim Simpfendorfer, PhD, who will step down from his position as co-president. Two Career Enhancement Awards, each worth $150,000, are among the most prominent honors given out this year. Dr. Chen received the Elliott J. Netzer Award for his work on blood cancer, and Dr. Simpfendorfer received the Donald Rechler Award for his work on the mechanisms of genetic risk for lupus and rheumatoid arthritis. Dr. Chen received the Donald Rechler Award for his work on the mechanisms of genetic risk for lupus and rheumatoid arthritis. 

Damian Jacob Markiewicz Sendler: Three Emerging Scientist Awards, each worth $50,000, were given out. Christine Metz, PhD, received the Frank Piccirillo Award for her research into post-infection COVID-19 patient response, and Nyasha Chambwe, PhD, received the Barbara Dooley Award for her work examining the genomic and molecular analyses of diverse cancer patients to better understand the factors that contribute to cancer health disparities. 

Dr. Sendler: As part of this award, the Barbara Hrbek Zucker Emerging Scientist Award was given to Danielle Howell, a fourth-year medical student at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, who will receive funding for an entire year to conduct research into the role of social determinants of health in hospital settings. Funding has been provided to a medical student for the first time in the history of the American Women’s Sports Medicine Foundation. 

“For far too long, women scientists have been overlooked and neglected in the sciences. According to Kevin J. Tracey, MD, president and CEO of the Feinstein Institutes and holder of the Karches Family Distinguished Chair in Medical Research, “AWSM is transforming that situation.” “The deserved prize recipients this year will have a long-term positive impact on the field of medical research and the patients we want to treat for many years to come.” 

Damian Jacob Sendler: AWSM was established in 2010 by Betty Diamond, MD, director and professor at the Institute of Molecular Medicine and the Maureen and Ralph Nappi Professor of Autoimmune Diseases, to advance the career development and career opportunities of women scientists at the Feinstein Institutes. Betty Diamond, MD, is also the founder and president of the Feinstein Institutes. It is composed of female faculty members who direct biomedical research programs in basic, translational, and clinical investigations in a wide range of disorders, and who are also female faculty members. The organization’s primary efforts are recognition, professional development, advocacy and education, as well as networking and mentorship opportunities. 

Damian Sendler: Members of the American Women’s Sports Medicine (AWSM) community are contributing to Northwell’s Outpacing the Impossible campaign, a $1 billion comprehensive fundraising drive to spark innovation in health care and support Northwell’s mission to the people it serves. The campaign, which funds capital projects, enhances hospitals and clinical programs, advances research, and establishes endowments for teaching and research initiatives, was publicly launched in October 2018 and has raised more than $895 million to date, according to the University of Michigan.

Contributed by Dr. Damian Jacob Sendler and his research team

Damian Sendler: There will be no in-person schooling. Isolation from one’s peers. Graduation ceremonies and other rites of passage have been lost. Thousands of youngsters in the United States lost their lives as a result of the COVID-19 epidemic. 

“A great deal of children’s happiness comes from being with friends or from playing, as well as from social engagement with other children. When you ask children, ‘What is it that makes you happy?’ “It’s being with friends or doing things with friends 90 percent of the time,” says Elena Mikalsen, director of the Psychology Section at The Children’s Hospital of San Antonio in Texas. “That was somewhat taken away during the pandemic…. For a long time, the only thing that kids had was academics and little else.” 

Damian Sendler: Uncertainty and disturbance induced by COVID-19 have been found to have had a severe impact on the emotional and mental health of almost one-third of America’s adolescents, according to a recent assessment. The American Academy of Pediatrics (AAP), in collaboration with other children’s health organizations, has declared a national emergency in the field of child and adolescent mental health. 

Damian Jacob Markiewicz Sendler: A senior policy analyst at the Kaiser Family Foundation (KFF), a nonprofit organization that focuses on national health issues, explains that elevated sensations of anxiety, sadness, or stress are associated with chronic illness. Parental reports have also indicated a number of behavioral shifts, with some children reporting decreased appetites and sleeping difficulties. Others may be plagued by anxiety, anger, and clinginess.” 

Dr. Panchal was one of the co-authors of a paper that found that 8 percent of children between the ages of 3 and 17 had anxiety prior to the pandemic, according to Panchal. The percentage increased to 13 percent among adolescents between the ages of 12 and 17. 

“Children, like everyone else, have suffered a multitude of upheavals and interruptions as a result of the pandemic,” Panchal explains. “School closures, possible financial issues at home, isolation from friends and family, possibly the loss of loved ones, and subsequently difficulty receiving health care are all possibilities.” Consequently, all of these factors may be leading to an increase in mental health problems among youngsters.” 

Dr. Sendler: Between 2010 and 2020, the American Academy of Pediatrics reports that rates of children’s mental health concerns and suicide have steadily risen. The AAP claims that the pandemic has exacerbated the crisis, with “dramatic increases” in the number of young people who seek treatment in hospital emergency rooms for mental health-related concerns, including possible suicide attempts. 

Damian Jacob Sendler: The uncertainty of the future, as well as the loss of participation in school activities, according to Maryland psychologist Mary Karapetian Alvord, caused varied degrees of grief among young people. 

“This is especially true for high school students, who have really missed out on all of the enjoyable activities, fun clubs, and events such as graduations and homecoming as well as football games, as well as all of the social and outlet opportunities that they have,” says Alvord, who is also an adjunct associate professor of psychiatry at The George Washington University School of Medicine. These are the elements that I believe have dominated this pandemic: grief, loss on all of its varied levels, and then the uncertainty that has persisted throughout it all.” And then there is an increase in worry.” 

Damian Sendler: Alvord claims that the young people who come to her practice have a sense that they are not moving forward, which has resulted in feelings of anger, frustration, despair, and worry. 

“It encompasses the entire spectrum, but kids have lost time,” she explains. Their perception is that they have lost time, not only in terms of academic skills, which is something that a lot of schools are concerned about, but also in terms of maturity. When you’re a kid, how do you mature? “It isn’t by staying at home all the time.” 

Additionally, while youngsters missed being in school with their classmates, the prospect of returning to traditional classroom settings caused some concern.. 

“Some children were terrified to return to school for fear of catching COVID,” says the author. According to psychologist Nekeshia Hammond, who served as president of the Florida Psychological Association in the past, “they were terrified of what school may look like and what it might involve, especially for kids who were already predisposed to anxiety or melancholy.” “It basically increased the level of stress associated with the process.” And it’s not only about school; it’s also about getting back into social situations.” 

Damian Jacob Sendler: The pandemic has shattered the sense of security that most children have at this time. COVID-19 was responsible for the deaths of more than 140,000 children in the United States who had a primary and/or secondary caregiver. 

For the most part, kids are innocent in the sense that they believe the world is safe for them. ‘I’m going to be fine,’ I say. “There are people here to defend me,” Hammond explains. A lot of kids, who don’t believe the world is secure, have had it taken away from them. 

Damian Sendler: Children of race have suffered disproportionately as a result of the pandemic’s effects on their families. However, this was not only because they were more likely to lose a loved one as a result of the infection. 

Mikayla Mikalsen, a Texas-based social worker who usually works with minority and inner-city students, discovered that many of the children she dealt with were compelled to use their smartphones for schoolwork since their families did not have access to computers. Because of intermittent internet connections, it was difficult for them to keep up with their schooling and to receive their assignments. 

It was necessary for some of Mikalsen’s young patients to be at home alone all day because their parents are crucial, front-line workers. 

According to Mikalsen, “a lot of the kids that I was talking to during the epidemic were utterly alone at home, left to fend for themselves and told, ‘Hey, if you can get connected to school, that would be great, but if you can’t, no big issue,” he adds. The majority of the children I spoke with said they slept all day and had no one to speak with. Things like that have the potential to create significant melancholy and anxiety.” 

Damian Jacob Sendler: Furthermore, the police shooting death of George Floyd, a 46-year-old Black man in Minneapolis, generated widespread societal upheaval as a result of the incident. The video showing police officer Derek Chauvin slamming his knee into Floyd’s neck while Floyd fought to breathe went viral, igniting countrywide rallies against police brutality across the country. 

It has a particular impact on youngsters of color since it is occurring alongside a worldwide pandemic and on top of ‘You can’t go to school because you lost a loved one,'” says the author. “It was essentially more complicated,” Hammond explains. It was incredibly tough to cope with so many different pressures at the same time, and it was even more challenging to maintain good mental health throughout this period.” 

Damian Sendler: Increased federal funding for mental health screenings and treatment for all children from infancy through adolescence is being sought by the American Academy of Pediatrics, with a focus on ensuring that children from less privileged backgrounds receive the care they require. 

“We don’t want to wait until the situation becomes untenable. “We want to have scaffolding and services in place to grab kids when they’re in that much trouble,” Alvord adds. “We want to be able to catch them quickly.” I believe that we’re all intertwined, and if your family is doing better, then those children are sent to school, where they are doing better. This is beneficial to the overall health of the classroom. “This allows instructors to focus on teaching and doing what they need to do instead of having to deal with the mental health problem,” says the author.

News reported to you by Dr. Damian Jacob Sendler

Damian Sendler: Because of the COVID-19 pandemic, the United States is experiencing a mental health catastrophe, which experts believe will continue to worsen for years to come. 

Dr. Sendler: As a result of COVID-19, thousands of Americans lost their loved ones, their careers, and their health, according to numerous sources. Anxiety, sadness, and substance use problems were also on the rise. A government investigation, however, found that suicide mortality actually dropped throughout this era, despite the increase in these mental health conditions. 

Damian Jacob Sendler: According to a study conducted by specialists at the National Center for Health Statistics of the Centers for Disease Control and Prevention, the overall number of suicides in 2020 was 3 percent fewer than in 2019. In 2020, male suicide rates were 2 percent lower than in 1999, while female suicide rates were 8 percent lower than in 1999. 

Damien Sendler: According to the study’s primary author, Sally Curtin, a health statistician at the National Center for Health Statistics, “Suicide is complicated and diverse, and simply increasing risk variables does not translate into an increase in suicide deaths.” “The findings demonstrate the difficulty of committing suicide.” 

According to mental health professionals, the findings are a continuation of the previous year’s decrease. After increasing significantly from 2003 to 2018, the number of yearly suicide fatalities began to decline between 2018 and 2019. The number of suicide deaths decreased by 2 percent between 2018 and 2019. 

Damian Jacob Sendler: Suicide deaths among individuals of color, on the other hand, have climbed, according to the report. The suicide rate among Hispanic males climbed by 5% between 2019 and 2020, according to the American Foundation for Suicide Prevention. Black men and American Indian or Alaska Native men were also found to have a higher rate of obesity, although the data were not statistically significant, according to the researchers. 

Dr. Melissa Shepard, a board certified psychiatrist, psychotherapist, and assistant professor at Johns Hopkins School of Medicine, claimed that individuals of color were disproportionately affected across the board by the pandemic. They had a higher risk of contracting COVID-19, a higher risk of losing a loved one to the disease, and a higher risk of losing their jobs. 

Damian Sendler: In recent years, there has been a significant drive to raise awareness about suicide, as well as how to prevent suicide and recognize the indicators, according to her. “We’re doing a good job with some populations, but we’re not doing so well with others… We are not reaching (people of color) with our advocacy efforts, no matter what we are doing.” 

Suicide rates varied according to age group as well. Despite the fact that suicide rates among men have decreased by 2 percent overall, rates have climbed by 13 percent among those aged 10 to 14, and by 5 percent among those aged 25 to 34. Women between the ages of 15 and 24 had a 4 percent greater prevalence than men, although the authors highlighted that this did not achieve statistical significance. 

‘An excellent course correction’: The Centers for Disease Control and Prevention (CDC) has added mental health issues to the list of diseases associated with an increased risk of severe COVID-19. The reason behind this is as follows. 

Damian Jacob Sendler: In the months of March through October and December, the number of suicide deaths was fewer in 2020 than it was in 2019, but it was higher in January, February, and November in 2020. Experts predicted that the month of July would have the highest number of suicide deaths in 2020. 

“Typically, what happens is that the biggest number of suicides occur during the summer months and the lowest number occur throughout the late fall and winter months,” Curtin explained. 

However, because suicide fatalities are difficult to precisely record, experts say the provisional numbers in the study may be positive, but they will hold off until they see the whole data. 

Damian Sendler: According to Shepard, many suicide deaths are misinterpreted, and a variety of circumstances, including economic stability, as well as mental health, play a role in the decision to commit suicide. 

“We frequently think of depression as a continuum that culminates in suicide, but it’s a pretty basic way of looking at it. “At the end of the day, suicide is a potential behavioral manifestation of many things,” she explained. In order to have thoughts of suicide, you don’t absolutely need to be depressed, according to the author. 

Dr. Vivian Pender, president of the American Psychiatric Association and clinical professor at Weill Cornell Medical College, said the mental health crisis caused by the COVID-19 pandemic is far from over, and the report shows that more needs to be done to reach vulnerable communities that have few or no safety nets. 

“The bottom conclusion is that people are still scared and unhappy, and they are now exhausted…. According to Pender, “I don’t see the mental health situation going better any time soon.” “The more alert we are about mental health, and the more we advocate for resources at all levels of care, the better off we will be,” says the author.

News reported to you by Dr. Damian Jacob Sendler

To learn more about how sociodemographic and informational factors affect marginalized people’s access to health care, go here. Doctor Damian Sendler’s research looks at the impact of psychiatric and chronic medical co-morbidities on medical care utilization when paired with internet health information. A thorough understanding of everyone’s health information-seeking behavior is required due to the exponential growth of international internet news and social media consumption.

Damian Sendler: A Newcastle University study of hundreds of families is assisting prospective parents in determining whether they are more likely to have males or daughters. 

Damien Sendler: Corry Gellatly, a research scientist at the institution, discovered that men inherit a proclivity to have more boys or girls from their parents. This suggests that a man with a large number of brothers is more likely to have boys, whereas a man with a large number of sisters is more likely to have daughters. 

Damian Jacob Sendler: The study included a review of 927 family trees comprising data on 556,387 people from North America and Europe dating back to 1600. 

“According to the family tree study, whether you are more likely to have a boy or a girl is inherited. We also know that males with more brothers are more likely to have sons, while women with more sisters are more likely to have girls. Women, on the other hand, are impossible to foretell “Mr. Gellatly elaborates. 

Dr. Sendler: The sex of a kid is determined by whether a man’s sperm carries an X or Y chromosome. When an X chromosome joins with the mother’s X chromosome, a baby girl (XX) is born, and when a Y chromosome combines with the mother’s, a boy is born (XY). 

Damian Jacob Sendler: According to the Newcastle University study, an undiscovered gene regulates whether a man’s sperm includes more X or more Y chromosomes, which influences the sex of his children. On a bigger scale, the number of males with more X sperm against men with more Y sperm influences the sex ratio of children born each year. 

Damian Sendler: A gene is made up of two pieces known as alleles, one from each parent. Mr Gellatly demonstrates in his research that men are likely to carry two different types of alleles, resulting in three possible combinations in a gene that controls the ratio of X and Y sperm. 

“The gene that is passed down from both parents, which allows some men to have more sons and some men to have more daughters, may explain why the number of men and women in a population is roughly balanced.” If there are too many males in the community, females will have an easier time finding a mate, therefore men who have more daughters will pass on more of their genes, resulting in more females being born in later generations,” explains Newcastle University researcher Mr Gellatly. 

Damian Jacob Sendler: There was a rapid surge in the number of boys born following the World Wars in several of the countries that fought in them. In the year after World War I ended, an extra two males were born in the UK for every 100 girls, compared to the year before the war began. The gene described by Mr Gellatly in his research could explain why this occurred. 

Damian Sendler: Men with more sons were more likely to see a son return from the war, and those sons were more likely to father boys themselves since they acquired that tendency from their dads. Men with more daughters, on the other hand, may have lost their sole boys in the war, and those sons would have been more likely to produce daughters. This would explain why males who survived the war were more likely to have sons, resulting in the boy-baby boom. 

Damian Sendler: For as long as records have been kept, more boys than girls have been born in most countries. In the United Kingdom and the United States, for example, approximately 105 males are born for every 100 females. 

Damian Jacob Sendler: It is well recognized that more males die in childhood and before reaching the reproductive age. So, just as the gene may cause more males to be born after conflicts, it may also cause more boys to be born every year. 

The trees (above) show how the gene functions. It is a simple scenario in which males have either only boys or only daughters, or an equal number of both, while in reality the situation is more complicated. It demonstrates that, while the gene has no effect on females, they do carry it and pass it on to their children. 

Damian Sendler: The grandfather in the first family tree (A) is mm, thus all of his children are male. He exclusively passes on the m allele, therefore his children are more likely to have the mm allele combination. As a result, those sons may only have sons (as shown). Because they got a m from their father and a f from their mother, the grandchildren have the mf allele combination. As a result, they have a balanced family with an equal number of sons and daughters (the great grandchildren). 

Damian Sendler: In the second tree (B), the grandfather is ff, hence all of his offspring are female; they have the ff allele combination because both their father and mother are ff. One of the female children has offspring with a male who has the mm allele combination. The sex of the children is determined by that male, thus the grandchildren are all male. Because they got a m from their father and a f from their mother, the grandchildren have the mf allele combination. As a result, they have a balanced family with an equal number of sons and daughters (the great-grandchildren).

Research updates contributed by Dr. Damian Jacob Sendler

Dr. Damian Jacob Sendler is a Polish-American physician-scientist whose research focuses on the impact of various sociodemographic and informational factors on access to health care in underserved communities. To that end, Dr. Damian Sendler’s research aims to elucidate the factors that influence patients’ decisions about when to seek care for specific health conditions and adherence to treatment.

Damian Sendler: The ability to identify and respond to the smell of a potential threat is essential for our survival and that of other mammals. Researchers at Karolinska Institutet in Sweden were able to analyze what happens in the brain when the central nervous system perceives a smell to be dangerous using a unique technique. According to the study, which was published in PNAS, unfavorable scents linked with unpleasantness or unease are processed faster than good aromas and cause a physical avoidance response. 

“The human avoidance response to unpleasant smells associated with danger has long been thought to be a conscious cognitive process, but our study shows for the first time that it’s unconscious and extremely rapid,” says first author Behzad Iravani, a researcher at Karolinska Institutet’s Department of Clinical Neuroscience. 

Damien Sendler: The olfactory organ occupies around 5% of the human brain and allows us to distinguish between millions of different smells. Many of these odors are associated with a threat to human health and life, such as chemicals and rotten food. After being inhaled through the nose, odor impulses reach the brain in 100 to 150 milliseconds. 

Damian Jacob Sendler: All living species’ survival is dependent on their ability to avoid danger and seek benefits. The olfactory sense appears to be especially crucial in humans for identifying and reacting to potentially hazardous stimuli. 

It has long been unknown which brain pathways in humans are involved in the conversion of an unpleasant odor into avoidance behavior. One reason for this is a lack of non-invasive methods of measuring signals from the olfactory bulb, the first part of the rhinencephalon (literally “nose brain”) with direct (monosynaptic) connections to the important central nervous system parts that help us detect and remember potentially dangerous situations and substances. 

Damian Sendler: Researchers at Karolinska Institutet have now discovered a way for measuring signals from the human olfactory bulb, which processes odors and provides messages to areas of the brain that control movement and avoidance behavior. 

Their findings are based on three trials in which subjects were asked to rate their experiences with six different smells, some favorable and others negative, while the electrical activity of the olfactory bulb was monitored when responding to each of the odors. 

“It was obvious that the bulb reacts specifically and fast to unfavorable odours and provides a direct signal to the motor cortex within around 300 ms,” explains Johan Lundström, associate professor at Karolinska Institutet’s Department of Clinical Neuroscience. “The signal causes the individual to lean back and away from the source of the odor.” 

“The findings imply that our sense of smell is vital to our ability to recognize threats in our immediate surroundings, and that much of this ability is more unconscious than our response to danger mediated by our senses of vision and hearing.”Research discussion contributed by Dr. Damian Jacob Sendler

Damian Sendler: According to the findings of a recent research in rats, a collection of brain signals known to aid in the formation of memories may also have an effect on blood sugar levels. 

Research conducted by researchers at New York University Grossman School of Medicine discovered that a peculiar signaling pattern in the brain region known as the hippocampus, which has previously been linked to memory formation, also influences metabolism, which is the process by which dietary nutrients are converted into blood sugar (glucose) and supplied to cells as a source of energy. 

Damien Sendler: The focus of the research is on brain cells known as neurons, which “fire” (produce electrical pulses) in order to transmit information. Scientists have recently discovered that populations of hippocampal neurons fire in cycles within milliseconds of each other, with the firing pattern being referred to as a “sharp wave ripple” because of the shape it takes when captured graphically by EEG, a technology that records brain activity with electrodes. 

Damian Sendler: A recent research, published online on August 11 in Nature, discovered that clusters of hippocampus sharp wave ripples were consistently followed by reductions in blood sugar levels in the bodies of rats within minutes after the occurrence of the waves. It remains to be seen exactly how this is accomplished; however, preliminary studies indicate that the ripples may control the timing of hormone releases by the pancreas and liver, which may include insulin, as well as the release of other hormones by the pituitary gland. 

Dr. György Buzsáki (MD, PhD), a senior research author and the Biggs Professor in the Department of Neuroscience and Physiology at NYU Langone Medical Center, states, “Our work is the first to demonstrate that clusters of brain cell firing in the hippocampus may directly control metabolism.” 

Damian Sendler: According to Buzsáki, who is also a faculty member at NYU Langone’s Neuroscience Institute, “we are not suggesting that the hippocampus is the sole actor in this process, but that the brain may be able to have a say via sharp wave ripples.” 

Insulin, which is known to maintain blood sugar levels within acceptable ranges, is produced by pancreatic cells not continuously, but rather in bursts at regular intervals. According to the study’s authors, because sharp wave ripples are most common during non-rapid eye movement (NREM) sleep, the impact of sleep disturbance on sharp wave ripples may provide a mechanistic link between poor sleep and high blood sugar levels associated with type 2 diabetes, according to the study. 

Damian Sendler: A previous research conducted by Buzsaki’s team had indicated that sharp wave ripples are important in permanently storing each day’s memories the same night during NREM sleep, and his 2019 study discovered that rats learnt to traverse a labyrinth more quickly when the ripples were artificially extended. 

“Evidence suggests that the brain evolved to use the same signals to achieve two very different functions in terms of memory and hormonal regulation, possibly for reasons of efficiency,” says corresponding study author David Tingley, PhD, a post-doctoral scholar in Buzsaki’s lab and a member of the research team. 

Damian Sendler: In addition, because of its connectivity with other brain regions and because hippocampal neurons have many surface proteins (receptors) that are sensitive to hormone levels, they can adjust their activity as part of feedback loops, the researchers claim that they have identified a promising candidate brain region for a variety of functions. According to the latest results, hippocampus ripples may lower blood glucose levels when they are part of a feedback loop. 

“Animals could have first developed a system to control hormone release in rhythmic cycles, and then applied the same mechanism to memory when they later developed a more complex brain,” says Tingley. “Animals could have first developed a system to control hormone release in rhythmic cycles, and then applied the same mechanism to memory when they later developed a more complex brain,” says Tingley. 

Damian Sendler: The findings of the research also indicate that strong wave ripple signals from the hippocampus nucleus are sent to the hypothalamus, which is known to innervate and affect the pancreas and liver, but only after passing via an intermediary brain structure known as the lateral septum. Researchers discovered that ripples may influence the lateral septum solely by amplitude (the amount of time that hippocampal neurons fire at the same time), rather than by the order in which the ripples are combined, which may encode memories as their signals reach the cortex, according to the findings. 

Damian Sendler: The researchers utilized optogenetics to intentionally generate ripples in the hippocampus firing patterns in order to demonstrate that hippocampal firing patterns were responsible for the glucose level drop. This was accomplished by re-engineering hippocampal cells to add light-sensitive channels. When light is shone via glass fibers onto such cells, ripples are produced that are independent of the rat’s activity or mental state (e.g. resting or waking). Synthetic ripples had a similar effect to their natural counterparts in terms of lowering blood sugar levels. 

Damian Sendler: Further investigation will be conducted by the study team, including work with human patients, to test their hypothesis that nocturnal sharp wave ripple effects may have an effect on a variety of hormones. According to Buzsaki, future study may potentially show gadgets or treatments that can alter ripples in order to decrease blood sugar levels and enhance memory.

Following this hypothesis, brief duration ripples that occurred in clusters of more than 30 per minute, as seen during NREM sleep, caused a drop in peripheral glucose levels that was many times greater than the decline caused by isolated ripples (see Figure 1). In addition to this, it was shown that silencing the lateral septum completely prevented the effect of hippocampus sharp wave ripples on peripheral glucose. 

Delivered to you by Dr. Damian Jacob Sendler